The Joint Commission, which accredits and certifies more than 20,000 health care organizations in the United States, has set a patient safety goal to accurately and completely reconcile medications as patients move through all health care settings. The process involves comparing a patient's current medication regimen against a physician's admission, transfer or discharge orders to identify discrepancies.
Jonathan D. Hron, MD, FAAP, a pediatric hospitalist at Boston Children's Hospital and an instructor of pediatrics at Harvard Medical School, led a team that implemented a quality improvement project that focused on reducing medication errors due to breakdowns at hospital admission. A group of physicians, pharmacists, nurses and information technology specialists worked together to test, implement and train clinicians to use a tool, which facilitates review of a patient's complete medication history when the child is admitted to the hospital.
The tool, which is part of the hospital's electronic health record system, was piloted in one area of the hospital and gradually was expanded to the entire hospital. "We successfully implemented the medication reconciliation application throughout the hospital, changing the practice of our entire staff," Dr. Hron said.
Using an existing voluntary error reporting tool, Dr. Hron and his colleagues then looked at the number of medication errors that occurred before and after implementation of the electronic tool.
About 33,000 children were admitted to Boston Children's Hospital during the study period, and the medication reconciliation tool was used for 75 percent of admissions after the intervention. The recording of medication history improved from 89 percent of admissions before the tool was implemented to 93 percent of admissions afterward. During the study, 146 medications errors due to missing or incorrect information at admission were detected. The error rate decreased by about 50 percent after hospital staff starting using the tool from 5.9 errors per 1,000 admissions to 2.5 errors per 1,000 admissions. Most of the errors did not harm patients, while 1 percent required additional monitoring or intervention but did not cause permanent harm.
"Careful medication reconciliation is essential to providing patient care, and it requires teamwork between doctors, nurses and pharmacists," Dr. Hron said. "If it's not being done in a systematic way, it's not being done right."