Reconciling Medications. Safe Practice Recommendations and Implementation Strategies. Medication Safety Facts. Medication errors account for more than 7,000 deaths annually
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Safe Practice Recommendations
A systematic process to reduce the number of medication events occurring at interfaces of care
Creating the most complete and accurate list possible of all home medications for each patient and then comparing that list against the physician’s admission, transfer, and/or discharge orders. Discrepancies are brought to the attention of the physician and, if appropriate, changes are made to the orders. Any resulting changes in orders are documented.
[Rozich, Resar 2001]
Source: Luther Midelfort Hospital -- Mayo Health System chart review
“We found that the list of medications that details current drug use
was either nonexistent or wrong more than 85% of the time”
[Rozich/Resar 2004, p.8]
Studies show over half of patients have discrepancies between home medications and medications ordered at admission, many with potentially serious results
A process to obtain the best home medication list possible through a defined resource list and active review of the patient’s medical history.
Patient’s Med List
Utilize strategic interviewing practices.
Ask open ended questions to obtain info on OTC meds & herbals.THE PROPOSED SOLUTION
Getting the home med list (at intake)
Writing medication orders
Identify and reconcile discrepancies
Order (no omissions, no duplicates, right med/dose/
Communicate (to next level of service)
What have we learned?
Who? Shared responsibilities, always someone with sufficient expertise:
[Michels/Meisel 2003; Gleason/Groszek 2004]
What have we learned?
Implementation Strategies through a defined resource list and active review of the patient’s medical history.
The goal of reconciling is to design a process that will ensure the most accurate patient home medication list available, thus reducing the number of medication events upon admission, transfer and discharge
Difficult task: but not impossible
Keep an updated list of all medications including herbals, vitamins and OTC. Including dosage and reason for taking the drug
Include all allergies and describe reaction
Include immunization history
Take the list to all doctor visits and medical testing labs, as well as pre-assessment visit for admission or surgery and all hospital visits including ER
When you leave the hospital, be sure to update your list with new medications and ask if any medications are duplicated
Keep this list in with you at all times
Measurement through a defined resource list and active review of the patient’s medical history.
Luther Midelfort Implementation Impact
Source:University of Kansas Hospital
Terry Rusconi 
Is through a defined resource list and active review of the patient’s medical history.
Documented on -
List all that apply
al? Y or
Y or N or
Y or N or ?
No or ?
Total (1) Blanks
Total (5) N or ?
Total (2) Blanks
Total (9) N or ?
P = patient
V = VNA
100 - ED sheet
Total (3) Blanks
Total (6) Blanks
F = family
N = Nursing home
200 - RN admission
Number of Meds
Total (7) Blanks
Rx - RX bottle
C = Pharmacy
300 - H & PE
Total (8) Blanks
H = History
400 - PAT form
Total ordered meds
M = MD office
500 - NoneCollecting your data
Beyond Admission through a defined resource list and active review of the patient’s medical history.
Proceed with caution, but efficiency gains
If you can’t do it on paper,
don’t even try it in vapor