Medication reconciliation is defined by JCAHO as â€œthe process of comparing a patient’s medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions.â€ The process should be fairly straight forward, but it is actually very difficult and time consuming.
Most consumers donâ€™t do a very good job of keeping track of their medications; much less the medication names, dosages, what they are used for and when they were last taken. Itâ€™s not uncommon on admission to the hospital for a patient to say things like â€œI take a blood pressure pillâ€ or â€œa pain pillâ€ or â€œa water pillâ€. As a pharmacist I can make gross generalizations about these medications, and can narrow the options down with aggressive questioning, but can rarely be sure without seeing the medication for myself.
The Electronic Health Record Incentive Program, a.k.a. Meaningful Use guidelines, calls for medication reconciliation to be used for at least 80 percent of â€œrelevant encounters and transitions of careâ€ (page 95). In addition â€œthe capability to perform medication reconciliation is included in the certification standards for certified EHR technology.â€ This is easier said than done.
Most medication reconciliation begins in the Emergency Department. It is typically a manual system of information collected by nurses who in turn pass it off to the physician for approval. Unfortunately many physicians don’t take the time to scrutinize the medication list which is often inaccurate or incomplete.
The ideal list of medications currently being taken by a patient wouldnâ€™t be generated by the patient at all. Instead the list would be downloaded from a nationally standardized e-pharmacy. Of course no such thing exists, but that doesnâ€™t mean it shouldn’t.
In theory all medications taken by patients are filled in a pharmacy, whether that is a chain pharmacy, community pharmacy or mail order pharmacy. Modern pharmacies are computerized and connected to the internet so that insurance adjudication can take place. The same data should be transmitted to a centralized e-pharmacy where it would be stored and accessed by hospitals during patient admissions. The list would follow the patient throughout their admission and be finalized on discharge. After all, the medication use profile is never more accurate than at the time of discharge.
In the absence of a centralized e-pharmacy, several vendors offer software applications designed to help hospitals maintain a digital medication reconciliation record. Most of these applications can be integrated into the pharmacy information system, making the process a little easier. The solution is not ideal, but it is better than a manual system with pen and paper.
Some vendors that offer medication reconciliation software are listed below.