J Clin Outcomes Manage
Medication reconciliation: are we meeting the requirements?
Holzmueller CG, Hobson D, Berenholtz SM, Feroli ER, Schwarz M, Wyskiel RM, Poe S, Pronovost PJ
Abstract Objective: To evaluate 2 medication reconciliation processes used at an urban academic medical institution. Methods: Results from a prescriber-led medication reconciliation process developed in response to a Joint Commission (JCAHO) patient safety goal were compared with a nurse-led reconciliation process implemented prior to the JCAHO requirement. Discharge orders on inpatients from 2 surgical intensive care units (ICUs) were reviewed. We calculated the percentage of ICU discharge orders with a prescriber signature attesting that reconciliation was done that contained at least 1 medication error. We defined a medication error as when the prescriber changed the ICU discharge order based on the nurse-led medication reconciliation process. Results: The nurses reconciled discharge orders from 104 patients in the ICUs. Of 104 discharge orders, 44 (42%) had a prescriber sign as reconciling the compiled medication list with the discharge order, and of those, 23 (52%) had at least 1 medication error identified by the nurse-led reconciliation. Conclusion: While our institution-wide prescriber-led medication reconciliation process met the JCAHO requirement, it had limited effectiveness for preventing errors in 2 ICUs. Given the resources devoted to meeting the JCAHO patient safety goal regarding medication reconciliation and limited evidence regarding the effectiveness of broad implementation, this patient safety goal could be reconsidered.
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