Pharmacists Key to Improving Medication Reconciliation

A pair of studies finds that when pharmacists take the lead in medication reconciliation, medication lists become more accurate, and medication errors decrease.

Pharmacist involvement is crucial for successful medication reconciliation, according to the results of a pair of recent studies. The studies, which were presented at the American Society of Health-System Pharmacists 2013 Midyear Clinical Meeting in Orlando, both found that medication list errors decreased when pharmacists completed medication reconciliation.

The first study found particularly impressive improvements in medication reconciliation after pharmacists took the lead. The researchers analyzed changes in admission and discharge medication lists after the implementation of a pharmacist-led medication reconciliation program at Little Company of Mary Hospital in Evergreen Park, Illinois. Pharmacists completed medication reconciliation for patients upon admission to the emergency department from September 2012 to March 2013. Admission and discharge medication lists were assessed for errors before the intervention in August 2011 and again in September 2012 and March 2013.

During medication reconciliation, pharmacists reviewed patient charts and medical history, interviewed the patient to obtain medication history, and often contacted outpatient pharmacies, family members, and physicians to ensure accuracy. The pharmacist would then update the patient’s electronic medical record and write a progress note, citing any recent changes in therapy and any recommendations for further therapy changes.

When pharmacists completed medication reconciliation, 94.2% of admission medication lists were accurate, compared with just 32.3% before the initiative was implemented. The average number of errors decreased from 2.94 per patient in August 2011 to 0.07 per patient in March 2013. The improvements in admission medication lists also led to more accurate discharge medication lists, although these improvements were less dramatic. With pharmacist intervention, 25% of discharge medication lists were accurate, compared with 16.7% before it was implemented. The average number of errors at discharge decreased from 4.2 errors per patient before the intervention to 2.92 errors per patient after it was initiated.

“Future plans involve including a pharmacist on discharge to further improve the accuracy of discharge medication reconciliation,” the authors of the study note.

The second study, which was conducted in a nonprofit hospital in Lincoln, Nebraska, where medication reconciliation is usually completed by nurses, also found improvements when pharmacists took over. In the study, 2 pharmacists completed the medication reconciliation process for 15 patients admitted to the hospital between May 9 and June 12, 2013. The number and type of errors resolved during pharmacist-led medication reconciliation were determined.

Overall, the pharmacists found and resolved 50 errors in medication reconciliation, with an average of 3.3 medication adjustments per patient. Incorrect information, including dose, route, and formulation, was the most common error, accounting for 68% of inaccuracies. Missing medications was the second most common error, accounting for 18% of errors. Other errors included compliance issues, variances, and extra medications. On average, the pharmacists took 39 minutes to complete medication reconciliation for each patient.

“Pharmacist completion of medication reconciliation decreased errors in medication reconciliation, which normally were accepted as an appropriate medication list,” the study authors write. “This study demonstrates the importance of pharmacist completion of medication reconciliation.”