Medication Reconciliation to Improve Quality of Transitional Care

Medication errors account for approximately 20 percent of all medical errors in the U.S. This significant source of error can cause injury and fatality, and occurs in all health care settings and all transitions in care. Recent studies have shown that electronic medication reconciliation for hospitalized patients can decrease medication discrepancies and significantly improve outcomes in transitional and ambulatory care. Relatively little is known, however, about the extent to which medication reconciliation systems improve clinical outcomes.

This project integrated an electronic medication reconciliation system with an electronic prescribing system and evaluated whether the resulting system altered the rate of medication reconciliation and the incidence of medication errors. This new module imported information about pre-admission medications and allowed clinicians to make corrections and annotations about them. The list of reconciled medications was available for use during ordering of inpatient medications. At discharge, the system prompted clinicians to indicate reasons for not creating new prescriptions for any pre-admission medications.

The specific aims of this project were to:

• Integrate an electronic medical reconciliation system with an e-prescribing system.
• Modify an electronic health record system to incorporate medication reconciliation.
• Conduct a randomized controlled trial of the medical reconciliation system.
• Determine whether electronic facilitation alters medical reconciliation and the incidence of medication errors in ambulatory care.

The project team conducted a randomized controlled study in which the intervention inpatient medicine teams had access to the new module and the control teams did not. Using a 6-month ambulatory followup period after discharge from the hospital, medical records were reviewed to determine whether medication reconciliation was conducted or if any adverse drug events had occurred. Clinicians were surveyed on their experiences in managing medications, and focus groups were held to augment that information.

Analysis of the data is underway. The initial round of the survey yielded approximately 268 responses and the second approximately 60. Eighty-three percent of respondents indicated that they usually ask patients to confirm their medications. Respondents indicating the availability of tools to manage medications increased from 36 to 58 percent. Ease in working with the tools increased from 31 to 51 percent, while perceived clinical benefits increased from 77 to 83 percent. The project team concluded that the process of medication reconciliation presents significant challenges to clinicians, including the time involved and role definitions. Process definition and tool provision can improve outcomes including usefulness, perceived benefits, errors in interpreting medication information, and time required.