When the patient transitions back home from hospital, the electronic medicines list automatically transfers into the hospital discharge summary, including the details of any medication changes. Changes are colour coded for the patient and general practitioner to easily identify.
Why is Medicines Reconciliation important?
Medicines Reconciliation helps ensure that the right medication is given to the right patient, at the right dose, and at the right time. Both while in hospital and on transfer back to the community.
Local and international studies have shown that:
- 70% of people who are admitted to hospital have at least one medication discrepancy between their inpatient medication chart and what they actually take in the community
- Up to one-third of these errors have the potential to cause harm
- More than 50% of all medication errors occur during transfers of patient care, i.e. between facilities and between wards
- Patients with one or more medicines missing from their hospital discharge information are more than twice as likely to be re-admitted to hospital than those with correct information on discharge
These findings highlight that the potential for medication-related harm occurring in hospital is high. Given the potential impact of medication errors, and the fact that many are avoidable, reducing these is one of our priorities.
What did we find?
We audited the discharge summaries between 2011-2013 of older adults at high-risk of readmission and this showed that:
- only 43% of patients’ discharge summaries contained a full and correct list of medicines
- 22% of discharge summaries had missing documentation around medication changes
- 26% had missing information about allergies and adverse drug reactions
What have we done?
We worked with Counties Manukau DHB to develop an electronic system (eMedsRec) in 2010. We have since rolled out the system to 22 medical, surgical and mental health inpatient areas across the organisation.
We have significantly increased our coverage of Electronic Medicines Reconciliation for patients over the last year:
- Counties Manukau District Health Board, Pharmacy department. Medication Reconciliation Audit, 2010 [unpublished].
- Cornish PL, Knowles SR, Marchesano R, et al. 2005. Archives of Internal Medicine 165: 424-9.
- Sullivan C, Gleason KM, Rooney D, et al. 2005. Medication reconciliation in the acute care setting: opportunity and challenge for nursing. Journal of Nursing Care Quality 20: 95-98.
- Stowasser DA, Stowasser M, Collins DM. 2002. A randomised controlled trial of medication liaison services - acceptance and use by health professionals. Journal of Pharmacy Practice and Research 32: 133-40.
- Croft D, Mohini P. WDHB Integrated Transition of Care project – Pharmacy data report. 2013 [unpublished].
Did we make a difference?
Electronic Medicines Reconciliation allows us to achieve greater accuracy and quality with our medication lists:
- patients’ medication lists are automatically transferred into their discharge summaries, which significantly reduces the chances of medicines being omitted
- any changes made to medicines require reasons to be documented before a discharge summary can be finished
- documentation of allergies and adverse drug reactions are now saved in the system for 10 years
We have received positive feedback from surveys sent out to both primary care and hospital medical officers:
Where to from here?
The next steps in the project are to:
- rollout eMedsRec to urology and elective surgery
- upgrade the software to allow eMedRec to be completed in clinic and outpatient settings
- re-audit patient discharge summaries to compare to baseline data