Medication reconciliation (MR) was identified as a National Patient Safety Goal in 2006 and during the summer of 2011 the Joint Commission is tracking it as a part of the accreditation process. Beyond its ties to regulatory bodies, MR is first and foremost a patient safety issue. Studies have shown that unintended medication discrepancies occur in nearly onethird of patients at admission and in 14% of patients at hospital discharge. These discrepancies can lead to lower patient satisfaction, readmissions, and more directlypatient harm. Given that, our goal was to improve our MR quality on admission and discharge. However, short of retrospective chart audits, tools for assessing the quality of MR are lacking.
To make a quantitative assessment of the quality of our MR process and further develop an electronic reporting system that will allow one to assess the impact of interventions designed to improve MR that can be followed over time and benchmarked.
After revising our institutional MR policy, in addition to launching an enterprisewide education and awareness initiative aimed at nurses, mid level providers and physicians, the functionality for adding prior to admission medications was enhanced for nurses. Data was extracted from our Electronic Health Records Enterprise data warehouse for the month of October 2010 and October 2011 for all Hospital Discharges. Approximately 4500 records in each comparison data sets were extracted and compared. This data included the number of patient discharges, medications that were input into a prior to admission medication list, the medication list of each patient at discharge, the number of medications that were reconciled on discharge and a drilldown report of all medications, pharmaceutical class, dose, route and frequency and prescription details.
Using this newly developed data extract tool, we were able to track dramatic improvements in MR over the past year. Specifically, for the Medicine Institute, the rate of patients discharged with unreconciled medications decreased from 26% to 13%. This data suggests that improving EHR functionality and educational campaigns can improve MR. The utility of this data extract around MR has many potential research and patient safety opportunities. Currently used as a tool to measure quantitative compliance, we are now innovating predictive models and rulebased alerts. We are actively looking at potential adverse drug events, prescribing errors, drugdrug interactions, and drugroute risks. By exposing the qualitative side of MR, we hope to be more proactive and realtime in addressing prescribing errors to ameliorate these risks.
To cite this abstract:Hamilton A, Li I, Morris W. A Viable Metric and Extraction Tool for Tracking Medication Reconciliation in the Electronic Health Record. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97740. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/a-viable-metric-and-extraction-tool-for-tracking-medication-reconciliation-in-the-electronic-health-record/. Accessed April 25, 2019.