Developing and Implementing a Novel Medication Reconciliation Tool for Use at Key Transitions During Inpatient Care

1VA Ann Arbor Healthcare System, Ann Arbor, MI
2University of Michigan Health Systems, Ann Arbor, MI
3University of Michigan Medical School, Ann Arbor, MI

Meeting: Hospital Medicine 2014, March 24-27, Las Vegas, Nev.

Abstract number: 236


Previous research suggests that over 60% of patients have a prescription medication discrepancy on admission to the hospital. At discharge, most patients have at least one new medication change from their home regimen but as many as 40% of these patients are not alerted to the change. These discrepancies have the potential for harm. Recognizing the potential for a high‐rate of adverse events, the Joint Commission on Accreditation of Health‐Care Organizations identified medication reconciliation as a national patient safety goal. At the approximately 150 Veterans Affairs (VA) medical centers, which represent the largest integrated system of healthcare delivery in the United States, there is no user‐friendly interface to reconcile inpatient and outpatient medications.


To develop a novel computer‐based medication reconciliation tool to be used during transitions of care and to assess physician perception and use of the tool.


In our web‐based tool all medications are combined into a single list from multiple care settings, including other VA facilities, and are displayed in an easy to compare fashion. Both newly‐initiated medications and those which have been held during hospitalization are highlighted allowing for rapid medication reconciliation. Our tool was piloted in July 2012 on one inpatient service at the Ann Arbor VA with expansion for use on all Veterans admitted to the internal medicine service in February 2013. During implementation, resident physicians attended an educational session on use of the tool. Residents were also given a checklist to use at admission and discharge that highlighted key steps in medication reconciliation. Finally, our clinical pharmacists used the physician‐generated list from our tool to educate patients. To date, more than 2000 providers have used the tool to reconcile medications for more than 50,000 patients (both inpatient and outpatient). In a survey of internal medicine residents, satisfaction with medication reconciliation increased from an average of 2.2 to 4.6 on a 5‐point Likert scale when the VA Computerized Patient Record System is compared to our new medication reconciliation tool. Importantly, certainty of admission medications increased from 2.3 to 3.6 and certainty of discharge medications increased from 3.2 to 4.0. Our tool is now used for medication reconciliation in over 95% of patients.


After a period of education, we found a high degree of satisfaction among users of our medication reconciliation tool. More importantly, we achieved a high level of use and increased certainty of patient medications. While such a tool can be used in the large number of VA hospitals without much difficulty, adapting it to non‐VA facilities will require additional modifications. Nevertheless, our novel medication reconciliation tool can be used relatively quickly to enhance the safety of Veterans across the United States.

To cite this abstract:

Dimcheff D, Kluk M, Solomon G. Developing and Implementing a Novel Medication Reconciliation Tool for Use at Key Transitions During Inpatient Care. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 236. Journal of Hospital Medicine. 2014; 9 (suppl 2). Accessed March 31, 2020.

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