Medication Reconciliation

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Medication Reconciliation Medication errors are serious patient safety problems that affect patient care outcomes and the attainment of the anticipated health goals and objectives. These errors can cause harm or death to a patient. The risk of medication errors is high among patients taking several medications. The errors can also arise when dealing with clients whose medication history is unknown. Studies show that over 40% of medication errors occur due to inadequate reconciliations in handoffs, medications, discharge, transfer and follow-ups of patients.

Medication reconciliations can prevent most of the medication errors experienced in clinical settings.

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Medication reconciliation refers to the formal process through which the clinician identifies all medication already prescribed to the patient and compares them with the patient’s medication orders and health records (Rose, Fischer & Paasche-Orlow, 2017). The process involves identifying the names, dosages, frequency, and routes of administration of these medications. This process is crucial when dealing with patients taking medications obtained from different sources. The clinician develops a list of all current medications and compares them with the prescribed medications (Rose, Fischer & Paasche-Orlow, 2017). The purpose of medication reconciliation is to prevent medication errors emanating from insufficient information regarding the client's medication history.

The impact of medication reconciliation on quality of care Medication reconciliation is an important medical practice that helps to reduce the risk of errors. Medication errors are likely to occur when a patient is being transferred from one setting to another. For instance, a client's medication history being admitted to the hospital may be overlooked leading to serious health problems. Literature reports indicate discrepancies of 30%70% between pre-admission and post-admission prescriptions (Byrne, Grimes, Jago-Byrne & Galvin, 2017). Medication reconciliation prevents such problems by enabling clinicians to generate reliable information concerning the past, current, and medications recommended for a client. The chances of a prescription being overlooked are minimal when appropriate medication reconciliation protocols are implemented. Studies show that medication reconciliation reduces medication errors by 50-90% (Makiani, Nasiripour, Hosseini & Mahbubi, 2017). This process enables clinicians to discontinue medications that can cause harm to the client. Certainly, this process leads to improved outcomes of care. Clients are provided with medications that address their health needs without augmenting the risk of complications and adverse drug-drug

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interactions. The process helps clinicians prescribe medications with minimal side effects, thus, reducing hospital readmissions (Makiani, Nasiripour, Hosseini & Mahbubi, 2017).

Issues Impacting Quality of Care The quality of care is influenced by various factors including communication, availability of resources, patient-related factors such as underlying health conditions, medical abbreviation and medication names. Poor communication affects the sharing of information in healthcare settings (Hughson, 2016). The factors contributing to poor communication include language barrier, workload pressure, ineffective procedures, poor documentation and poor communication skills (Helming, Shields, Avino & Rosa, 2020). Poor documentation makes it hard for clinicians to assess the health history of the client. The chances of prescribing potentially harmful treatment to a client are high if health data is not captured correctly. Medical errors also contribute to poor outcomes of care. These errors are associated with inadequate information flow, technical failures, staffing challenges, and poor communication (Helming, Shields, Avino & Rosa, 2020).

A lack of patient involvement in the care process can also negatively affect the quality of care.

Patients provide the clinician with feedback essential to modify the care delivery process to improve outcomes. Clinicians cannot adjust patient care if appropriate feedback is missing.

Gaps That Might Arise with Medication Reconciliation Medication reconciliation is a well-formulated process in primary care settings and works well if the clinician has taken over the prescribing processes and care-sharing responsibilities (Lakhani, 2019). However, some challenges may hinder the attainment of the anticipated reconciliation outcomes. Some gaps in the medication reconciliation process need to be looked into to streamline patient care processes. These gaps include the huge volume of medications per patient and inconsistent medication history (Lakhani, 2019). Due to the large number of

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medications being taken by some patients, it is common for hospitals to fail to capture each patient's complete medication details (Aghajani et al., 2016). Clinicians may leave some medications out of the reconciliation list thus putting the client in danger of adverse effects.

Mostly, clinicians rely on information provided by patients and families. Medication reconciliation is affected if these parties are unable to provide accurate information regarding medications and dosages. Another gap associated with medication reconciliation is that it does not provide information concerning current medications' side effects.

Populations at risk The people at risk of poor medication reconciliation outcomes include those taking multiple medications, elderly persons with poor cognitive capacity, people with psychological disorders, and children. Children for instance, are not able to provide accurate information concerning medications. Older people, on the other hand, suffer from comorbidities that require administration with multiple medications. It is common for some of these medications to be left out during reconciliation. The risk of medication errors is higher among elderly persons with chronic diseases that affect their medication control level.

Strategies to improve medication reconciliation Clinicians can use health technology platforms to resolve the challenges associated with medication reconciliation. Unlike humans and paper documents, healthy technology systems capture and store large quantities of health data for longer people (Clark, 2016). The ease of accessibility makes this data suitable for use during reconciliation. Nurses should capture medication data correctly in the system to ensure reconciliations do not run into problems.

Nurses also need to optimize interviews with patients and families to ensure relevant medication information is collected (Clark, 2016). Another strategy to resolve reconciliation challenges is

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establishing a transition of the care team. This team develops practical interventions to streamline the hospitalization, discharge and follow-up processes (Kreckman et al., 2018). A pharmacy team can also be established to help in compiling the mediation histories of each client. This team should tap into prescription databases to collect relevant medication information for all clients.

Conclusion Medication errors are serious patient safety threats that contribute to the poor outcome of care, prolonged hospitalization and increased burden of diseases. These errors are contributed by poor communication, staffing problems, and insufficient information flow in healthcare settings.

Clinicians perform medication reconciliation to reduce medication errors. This process generates vital information concerning current and to-be prescribed medications, subsequently helping clinicians to exclude medications that produce adverse drug-drug interactions, thus improving care quality. Challenges may occur during reconciliations especially when dealing with clients using multiple medications. The strategies to improve medication reconciliations include implementing health technology systems, comprehensive patient and family interviews, and establishing a care team's transition.

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References Aghajani, M., Ghazaeian, M., Mehrazin, H., Sistanizad, M., & Miri, M. (2016). Errors related to medication reconciliation: A prospective study in patients admitted to the post CCU. Iranian Journal of pharmaceutical research: IJPR, 15(2), 599. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5018288/ Byrne, S. M., Grimes, T. C., Jago-Byrne, M. C., & Galvin, M. (2017). Impact of team-versus ward-aligned clinical pharmacy on unintentional medication discrepancies at admission.

International journal of clinical pharmacy, 39(1), 148-155. https://doi.org/10.1007/s00228-017-2308-1 Clark, M., (2016). Medication Reconciliation: Practical Strategies and Tools for Compliance.

Hcpro, a Division of Blr, Helming, M. A. B., Shields, D. A., Avino, K. M., & Rosa, W. E. (2020). Dossey & Keegan's Holistic Nursing: A Handbook for Practice. Jones & Bartlett Learning.

Hughson, J. (2016). Tabbner's Nursing Care: Theory and Practice. Elsevier Health Sciences.

Kreckman, J., Wasey, W., Wise, S., Stevens, T., Millburg, L., & Jaeger, C. (2018). Improving medication reconciliation at hospital admission, discharge, and ambulatory care through a transition of care team. BMJ open quality, 7(2), e000281. https://doi.org/10.1136/bmjoq2017-000281 Lakhani, M. (2019). Too many cooks? Closing the gaps in medication reconciliation. Prescriber, 30(12), 29-30. https://wchh.onlinelibrary.wiley.com/doi/pdf/10.1002/psb.1810 Makiani, M. J., Nasiripour, S., Hosseini, M., & Mahbubi, A. (2017). Drug-drug interactions: the importance of medication reconciliation. Journal of research in pharmacy practice, 6(1), 61. https://dx.doi.org/10.4103%2F2279-042X.200992

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Riga, M. (Ed.). (2017). Impact of Medical Errors and Malpractice on Health Economics, Quality, and Patient Safety. IGI Global.

Rose, A. J., Fischer, S. H., & Paasche-Orlow, M. K. (2017). Beyond medication reconciliation: the correct medication list. Jama, 317(20), 2057-2058. http://doi:10.1001/jama.2017.4628