Improving the Interfaces of Care with Medication Reconciliation

Author: Fred M. Eckel, RPh, MS, Pharmacy Times Editor-in-Chief

Are you ready to "accurately and completely reconcile medications across the continuum of care?"This is one of the 2005 Hospitals' National Patient Safety Goals instituted by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Hospitals that wish to continue their accreditation by JCAHO must develop this year, for implementation by January 2006, a "process for obtaining and documenting a complete list of the current medications upon the patient's admission to the organization and with the involvement of the patient. This process includes a comparison of the medications the organization provides to those on the list."The process also must include communicating a complete list of medication "to the next provider of service when it refers or transfers a patient to another setting, service, practitioner, or level of care within or outside the organization."

This requirement for medication reconciliation is based on evidence that over half of all medication errors occur at the interface of care. Because medication errors are among the leading causes of hospital patient injuries, medication reconciliation is being required by JCAHO to help reduce the incidence of medication errors.

You say, however, "Why are you asking me if I am ready, when I do not practice in a hospital? That is the hospital pharmacist's responsibility, not mine." If the hospital pharmacist calls you for a complete list of all medications, prescription and OTC, as well as any herbals you sold to a specific patient, will you be able to help? When a patient is discharged from the hospital, and the hospital pharmacy sends you a complete list of medications the patient is currently prescribed, will you know what to do with it?

In talking to a few hospital pharmacists, I hear that they are just going to leave the patient's community pharmacist out of the loop because you do not care about getting this information and will not do anything with it if they send it. I think, however, that as a community pharmacist, you have a role to play in the medication reconciliation process. Hopefully by now, you have had some discussion locally about how it will occur in your community, and you know what information you are expected to supply, what information you will receive, and what you will do with it. If not, maybe you ought to call the local hospital pharmacy and talk with the pharmacists about how they plan to do medication reconciliation.

Some organizations are setting up a system in which patients are being asked to keep their own medication form in their wallet and update it every time they get a new prescription or try a new OTC or herbal product. When they stop taking a medication, they should draw a line through it on their medication profile. Patients might ask you to help them, but, with most of the forms I have seen, patients are not told to show their medication profile to their pharmacists.

It seems as if we still have a job to do to demonstrate to other health professionals, and maybe our colleagues in other practice settings, that community pharmacists have an important role to play in ensuring medication safety for patients.

Mr. Eckel is professor and director of the Office of Practice Development and Education at the School of Pharmacy, University of North Carolina at Chapel Hill.