Medication reconciliation is critical to avoid adverse drug interactions and prevent patient safety incidents.
Dr. Robert Latz
CIO, Trinity Rehabilitation Services; Member of Policy Steering Committee, College of Healthcare Information Management Executives (CHIME)
If you’ve been prescribed medicine during a healthcare encounter, chances are you’ve also been asked to verify the medicines you’re taking. The person asking is taking you through a process called medication reconciliation. This is the act of comparing the medicines listed in a person’s medical record to the medicines the person is actually taking.
Medication reconciliation is critical to avoid adverse drug interactions and prevent patient safety incidents, especially because so many people take medications. More than 50 percent of Americans take at least one prescription drug, nearly 25 percent take at least three prescription drugs, and of those 65 and older, more than 40 percent take five or more medications. Risk of error rises during transitions of care when patients are moved from one healthcare setting to another, such as from a hospital to an inpatient rehabilitation facility. If clinicians at the receiving care center are not aware of all medications a patient is taking, life-threatening complications can occur with any new prescription.
The information needed for a good, thorough medication reconciliation process extends beyond just the names of the medicines a person is currently taking. Knowing the facts about whether a medicine was discontinued and why, which medicines were prescribed but never taken, correct information on height and weight, or even a patient’s inability to swallow pills can all be helpful to avoid a serious medical event.
Technology and self-reporting
While healthcare technology has advanced by leaps and bounds over the past twenty years, the ability of clinicians to reconcile medications using electronic health records (EHRs) still needs improvement. When a person transitions between healthcare settings, and each setting uses a different software platform, then patient information may not be shared between these organizations.
In these instances, clinicians are left with incomplete lists of medications when a previous provider’s data does not show up in a patient’s record. Currently there is no single, comprehensive list of medications for the past year that can follow a patient from provider to provider across technology platforms. And when the medication list is incomplete or inaccurate, patients are in jeopardy of a potential adverse drug event.
Recent digital advances offer hope for progress in this area. For example, the College of Healthcare Information Management Executives (CHIME) and others are working to improve interoperability, or data sharing, at times of transitions of care. The 21st Century Cures Act of 2016 opened the door to better healthcare information sharing, and recent rules from the Office of the National Coordinator for Health IT (ONC) also encourage interoperability, including data sharing for medication reconciliation. In addition, industry groups are working together to bridge data gaps and make improvements to the process.
Technology is one piece of the puzzle. Patient self-reporting is another, and you can help — for yourself or a family member, especially at times of transitions of care. Please maintain a list of your medicines (prescribed and/or taken and/or discontinued) in the past year and share this list with clinicians at each care center.
The need for rapid improvement in medication management is even more pressing due to the additional strain on clinicians and patients stemming from the COVID-19 pandemic. With time running short in healthcare settings and staff shortages spreading across the nation, errors are more likely in the absence of accurate data.
Bringing efficiency and accuracy to the medication reconciliation process cannot come soon enough for overburdened providers. Reducing adverse events from medication errors must be an imperative for all of us.