Improving the Interfaces of Care with Medication Reconciliation

Are you ready to "accurately andcompletely reconcile medicationsacross the continuum of care?"This isone of the 2005 Hospitals' NationalPatient Safety Goals instituted by theJoint Commission on Accreditation ofHealthcare Organizations (JCAHO).Hospitals that wish to continue theiraccreditation by JCAHO must developthis year, for implementation by January2006, a "process for obtaining anddocumenting a complete list of the currentmedications upon the patient'sadmission to the organization and withthe involvement of the patient. Thisprocess includes a comparison of themedications the organization providesto those on the list."The process alsomust include communicating a completelist of medication "to the nextprovider of service when it refers ortransfers a patient to another setting,service, practitioner, or level of carewithin or outside the organization."

This requirement for medicationreconciliation is based on evidencethat over half of all medication errorsoccur at the interface of care. Becausemedication errors are among the leadingcauses of hospital patient injuries,medication reconciliation is beingrequired by JCAHO to help reduce theincidence of medication errors.

You say, however, "Why are youasking me if I am ready, when I do notpractice in a hospital? That is the hospitalpharmacist's responsibility, notmine." If the hospital pharmacist callsyou for a complete list of all medications,prescription and OTC, as well asany herbals you sold to a specificpatient, will you be able to help? Whena patient is discharged from the hospital,and the hospital pharmacy sendsyou a complete list of medications thepatient is currently prescribed, will youknow what to do with it?

In talking to a few hospital pharmacists,I hear that they are just going toleave the patient's community pharmacistout of the loop because you donot care about getting this informationand will not do anything with it if theysend it. I think, however, that as a communitypharmacist, you have a role toplay in the medication reconciliationprocess. Hopefully by now, you havehad some discussion locally about howit will occur in your community, andyou know what information you areexpected to supply, what informationyou will receive, and what you will dowith it. If not, maybe you ought to callthe local hospital pharmacy and talkwith the pharmacists about how theyplan to do medication reconciliation.

Some organizations are setting up asystem in which patients are beingasked to keep their own medicationform in their wallet and update it everytime they get a new prescription or trya new OTC or herbal product. Whenthey stop taking a medication, theyshould draw a line through it on theirmedication profile. Patients might askyou to help them, but, with most ofthe forms I have seen, patients are nottold to show their medication profileto their pharmacists.

It seems as if we still have a job todo to demonstrate to other health professionals,and maybe our colleagues inother practice settings, that communitypharmacists have an important roleto play in ensuring medication safetyfor patients.

Mr. Eckel is professor and director of theOffice of Practice Development and Educationat the School of Pharmacy, University ofNorth Carolina at Chapel Hill.