Effective inpatient medication reconciliation: The 10 commandments

Abstract

Medication Reconciliation (MedRec) is the comprehensive process of medication verification, clarification and documentation in an effort to avoid medication errors. There are many reasons that contribute to the inadequacies of current day inpatient MedRec. Among these include the limited medical literacy of patients, communication between providers and teams of providers, and the intrinsic difficulties of medical charting. Although the best approach to inpatient MedRec is not known, the following outlines the 10 most important aspects, or "Commandments", for effective inpatient MedRec. The tenets are not listed in any particular order of importance.

Medication reconciliation at hospital discharge: A qualitative exploration of acute care nurses’ perceptions of their roles and responsibilities

“…Overall, most nurses in our study perceived they had a minor role in medication reconciliation at hospital discharge with pharmacists and doctors having a major role. Some were unclear about their Nurses reported medication reconciliation at hospital discharge was a complex process involving numerous clinicians who completed similar tasks such as patient education (Penm et al, 2019;Siu, 2015).…”

“…Nurses reported medication reconciliation at hospital discharge was a complex process involving numerous clinicians who completed similar tasks such as patient education (Penm et al, 2019; Siu, 2015). Confirming previous research (Aires‐Moreno et al, 2020; Athuraliya et al, 2017), nurses in our study identified medication discrepancies, checked the accuracy of discharge medications, delivered patient education, and coordinated the healthcare team to ensure patient safety and avoid discharge delays.…”

“…Patients engage with nurses, doctors and pharmacists about their medications, so it is reasonable to share the roles and responsibilities of medication reconciliation at hospital discharge (Aires-Moreno et al, 2020;Fernandes et al, 2020). Hence, addi- Nurses reported medication reconciliation at hospital discharge was a complex process involving numerous clinicians who completed similar tasks such as patient education (Penm et al, 2019;Siu, 2015).…”

Phenytoin Toxicity

“…If there is no clear role designation, the ultimate responsibility of reporting falls on departmental leadership. 3 Delays in reporting (option 4) slow the improvement process. After an incident report is created, the hospital's quality team determines the incident severity.…”

Function-specific Design Principles for the Electronic Health Record

“… Define the terms 'medication' and 'reconciliation' to ensure uniformity with the medication reconciliation process (i.e., what constitutes a medication and what processes are encompassed by reconciliation) (Greenwald et al, 2010).  Define the varying roles of the multidisciplinary participants in the reconciliation process (Greenwald et al, 2010;Siu, 2015).  Enhance the accuracy of medication reconciliation with pharmacist involvement or pharmacist-related interventions (Mergenhagen et al, 2012;Mueller, Sponsler, Kripalani, & Schnipper, 2012).…”