Medical Professional Publications

Inadequate Reconciliation of Home Medications

(From the March 2013 Issue of MedStat)

Every four days, an adverse drug event (ADE) occurs related to inadequate reconciliation of patients’ home medications. Medication reconciliation is the process of comparing a patient’s medication order to all of the medications that the patient has been taking. It is performed to avoid errors such as omission, duplications, dosing and interactions. Full medication reconciliation requires a complete review of ALL medications and is performed on admission, transfer, discharge, prior to any surgery and during all primary care office visits. Focused medication reconciliation is a complete review of only those medications prescribed by the specialty service and medications having a direct impact on the chief complaint/reason for the visit in the emergency department or urgent care. A focused review is done in the emergency department, urgent care and specialty clinics.

The major contributor to inadequate medication reconciliation that leads to the most serious ADEs is the failure of practitioners to use the admission, transfer and discharge navigators in EPIC. These navigators are not the most “user friendly” of EPIC tools. However, improvements to our EPIC medication reconciliation process are currently being piloted in the Ambulatory Specialty clinics and will soon spread to all outpatient and inpatient units. The EPIC function will be improved, but the attention given to accuracy and completeness on the part of the prescriber is the defining factor in ensuring that the patient is receiving the correct medications at all times and that all providers have access to up-to-date information.

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