Medication reconciliation: An innovative approach

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How do you implement a medication safety initiative across five large facilities and five unique areas of patient care? St. Joseph’s Health Care, London is doing just that, and welcomes the challenge.

Medication Reconciliation (MR) is a formal, three-step process designed to prevent adverse drug events and medication errors at patient transfer points—admission, transfer and discharge.

Step 1: Create the most complete, comprehensive and accurate list possible of all medications actually taken by the patient. On admission, this may include medications taken at another facility as well as medications taken at home. This list is called the Best Possible Medication History (BPMH).

Step 2: Use the BPMH when writing medication orders.

Step 3: Compare the BPMH to the prescriber’s orders, identifying discrepancies and resolving these discrepancies in collaboration with the prescriber (reconciliation).

“Medication reconciliation is a shared responsibility, involving the client, nurse, medical staff and pharmacy staff,” explains Sandy Jansen, St. Joseph’s medication safety coordinator. “Everyone must work together for the best outcome.” Broad involvement in medication reconciliation will help to ensure that factors such as patient illness, patient knowledge, language barriers, access to family members, and access to community resources (e.g. pharmacist, family physician) are well-managed, and the risk of medication errors is reduced.

“Due to the diversity of our patient population and care structures, the medication reconciliation team is meeting with each individual patient care area to determine how to best refine the process so that it can be embedded easily into their everyday practice,” says Jansen. Processes and tools that will be common in all locations include: an education and communication package for all staff; the BPMH documentation form; admission medication order form; and data collection and reporting processes. A broad educational approach—including staff education sessions, written materials, one-on-one meetings, and on-line resources—is essential to rolling out the initiative across St. Joseph’s varied and distinct care environments.

“As our work evolves in this initiative,” says Sandy, “we are mindful of our guiding principle: An up-to-date and accurate medication list is essential to ensure safe prescribing in any setting. If we stick to our guiding principle and simply ‘adjust the sails’ with each area implementation, it will ensure a flexible and innovative approach that is crucial for our unique organization.”