Medication errors are a key patient safety issue across all health care settings as medication lists can quickly become inaccurate when patients are referred or transitioned to other providers.
Such medication errors account for an estimated 3.5 million physician office visits and 1 million emergency room trips per year. When providers fail to adequately monitor medications and check for adverse events or nonadherence with prescriptions, preventable readmissions increase.ii Affecting more than 7 million patients, preventable medication errors rack up nearly $21 billion in associated health care costs annually.i
A key strategy in avoiding adverse drug events is making a list of medications a patient is currently using and comparing it to a “single source” document, also known as medication reconciliation. Because medical errors can occur during routine exams, admissions, or post-discharge, it is important to use a consistent medication reconciliation protocol across all components of a patient’s care.
Factors requiring special attention
Certain patient risk factors – such as language barriers, hearing and visual impairment, and cultural differences – are associated with medication discrepancies and the need for vigilance in medication reconciliation. These risk factors are particularly prevalent among the elderly, as well as patients with low health literacy, cognitive impairment, or polypharmacy. Other common patient interactions with medications where there is an increased vulnerability to error include:
- New/discontinued medications
- Medications without instructions on stop date or duration of therapy
- Prescribed medication nonadherence
- Nonprescription medication use
- Medication use in preparation for a procedure or post-procedure
- Multi-provider associated medication duplication or interaction
In the primary care setting, medication errors are as high as 94 percent.iii Therefore, providers must establish a process for timely, accurate medication information sharing with their patients. This is also important when patients need surgical procedures or are referred to specialists. Sharing information with patients helps avoid confusion, reduces health risks, and improves medication adherence.
As is true in the inpatient setting, providers in the ambulatory surgical/procedural setting must know the medications patients are taking prior to a procedure to avoid dangerous reactions, such as, increased risks of excessive bleeding, uncontrolled blood sugar, and other patient risks or uncontrolled chronic diseases. Similarly, providers must clearly communicate instructions for any post-procedure prescriptions.iv,v Failure to ensure medication reconciliation before or after a procedure can lead to serious health consequences.
Steps to medication reconciliation
Regularly discussing medications with patients has benefits beyond reducing the risk of an adverse reactions. Complete and consistent medication reconciliation can foster communication between providers and patients, resulting in strengthened coordination of care, increased patient engagement and satisfaction, and overall improved quality of care. To ensure your medication reconciliation process is complete, consider these five key steps:
- Commit to medication reconciliation as part of the “culture of safety” at your organization.
- Obtain “buy-in” from key stakeholders such as administrators, pharmacists, and other healthcare providers.
- Conduct ongoing review of processes/staff training.
- Implement a “single source” document policy to foster consistent recording of patient medications.
- Educate all existing and new staff on the importance of the policy.
- Ensure the single source document is easily available either as part of the electronic health record (EHR) or a centrally-located hard copy.
- Verify and document medications before and after each patient exam or procedure.
- Communicate with the patient at the start of the visit, document medications, and then make any necessary changes upon patient discharge (or completion of her/his primary care visit).
- Resolve any medication discrepancies through communication with patients, other providers and/or the pharmacy.
- Accomplish this BEFORE the patient leaves the visit/procedure.
- Ask patients to verify the current medication list and ensure they understand how and when to take their medications.
- Create a process to reach out to the patient if the medication reconciliation was completed AFTER the patient has left the facility.
References:
i Da Silva BA, Krishnamurthy M. The alarming reality of medication error: A patient case and review of Pennsylvania and national data. J Community Hosp Intern Med Perspect. 2016 Sep7; 6(4):31758.
ii Auerbach AD et al. Preventability and causes of readmissions in a national cohort of general medicine patients. JAMA Intern Med. 2016 Apr;176(4):484-493.
iii Rose O, Jashde U, Koberlein-Neu J. Discrepancies between home medication and patient documentation in primary care. Res Social Adm Pharm. 2017 Apr 8. [Epub ahead of print] iv Thanavaro JL. Cardiac risk assessment: Decreasing postoperative complications. AORN J. 2015 Feb; 101(2):201-212.
v Smith I, Jackson I. Beta-blockers, calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers: Should they be stopped or not before ambulatory anesthesia? Curr Opin Anaesthesiol. 2010 Dec;23(6):687-690.
