Could Medication Reconciliation Reunite the Profession?
Mr. McAllister is Pharmacy Times Editor, Health-systems Pharmacy Section and director of pharmacy at University of North Carolina Hospitals and Clinics.
The Joint Commission on Accreditation of Healthcare Organizations now mandates that medication reconciliation be performed and documented each time a patient is admitted, transferred, or discharged. The intent is to improve the quality of care by reducing medication errors that may occur as the patient transitions from one care environment to another, by ensuring that prescribed pharmacotherapy is reviewed for accuracy and appropriateness.
Hospitals have responded by implementing policies and procedures that assign the responsibility to physicians, nurses, or pharmacists. In the April 2004 issue of Pharmacy Times, I mentioned some of the reasons that pharmacists should assume these responsibilities in my commentary entitled ?Continuity of Care?Present and Future? (view this article at www.pharmacytimes.com/continuity).
At the recent American Society of Health-System Pharmacists Summer Meeting?s Open Hearing of the House of Delegates, a discussion on medication reconciliation reflected a broad array of sentiments from those in attendance regarding organized pharmacy?s ability and interest in assuming this responsibility. I was disappointed by those who suggested that pharmacists were too busy or otherwise unable to provide such services, but buoyed by those who recognized the value that could result and their willingness to accept the responsibility. Without question, the predominant reason for deferring this responsibility to physicians or nurses was that pharmacists do not have the time to do admission histories or discharge counseling, and that acquiring additional personnel to do so would be challenging if not impossible.
Without question, assuming these new responsibilities will take a considerable investment of time on the part of existing staff members, and probably additional staff members in some hospitals. The return on that investment, however, in terms of improving patient safety and enhancing the value of pharmacists, is multifold. I suspect that community pharmacists have similar anxieties about the time required with respect to patient counseling or providing their patients with a comprehensive medication profile prior to hospital admission.
We will need to use our creativity, technology, and careful introspection to devise strategies to meet these new expectations. Regardless of the setting in which any pharmacist practices, we have the skills to provide these services and have been taught the importance of and responsibility for providing them during our professional training.
It occurs to me that medication reconciliation could become the starting point for improving the collaboration between acute care and community pharmacists, but only if there is widespread adoption of these responsibilities in all practice settings. Using technology to efficiently communicate updated medication profiles will help immensely. Creating partnerships between practitioners in different settings who share information on behalf of patients and the personal attention to each patient will send a powerful message to those we serve regarding the essential role we play in health care.
I am hopeful that pharmacists who practice in hospitals and health systems will step up to the plate and improve patient safety by ensuring that medication reconciliation takes place. We need to take it one more step, however, and embrace our colleagues in other practice settings to maximize the effectiveness and value of the entire profession.