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PRATHIBHA VARKEY, M.D., M.P.H., is Assistant Professor of Medicine and Preventive Medicine, Division of Preventive and Occupational Medicine; JULIE CUNNINGHAM, PHARM.D., is Instructor of Pharmacy, Department of Pharmacy; JOHN O’MEARA, PHARM.D., is Instructor of Pharmacy, Department of Pharmacy; and ROBERT BONACCI, M.D., is Instructor of Family Medicine, Department of Family Medicine, Mayo Clinic College of Medicine, Rochester, MN. NIMA DESAI, M.D., is Instructor of Family Medicine, Department of Family Medicine, Park Nicollett Methodist Hospital, St. Louis Park, MN. ROBERT SHEELER, M.D., is Associate Professor of Family Medicine, Department of Family Medicine, Mayo Clinic College of Medicine.

Address correspondence to Dr. Varkey at the Mayo Clinic College of Medicine, Baldwin 5A, 200 1st SW, Rochester, MN 55905 (varkey.prathibha{at}mayo.edu).

Purpose. The effectiveness of a multidisciplinary medication reconciliation process was studied in an inpatient family medicine unit of an academic hospital center. Methods. In phase 1 of this two-phase study, nurses, pharmacists, and physicians used an admission medication reconciliation form to reconcile patients’ home medications on admission. The form was then reviewed by the pharmacist on the unit and by the attending physician, who reconciled the discharge medication list. The discharge medication list was compared against the patient’s home medications list, inpatient medication profile, and prescriptions documented in the electronic medical record to investigate any medication discrepancies. Pharmacists participating in the study documented and categorized medication discrepancies by the potential severity of the error. In phase 2, family medicine medical residents and staff were instructed to include reconciled admission and discharge medication lists in the hospital summary. Results. A total of 102 patients formed the study sample. There was no significant difference between phase 1 and phase 2 patients in mean age, sex, and length of hospital stay. Totals of 432 and 367 admission medications required reconciliation during phase 1 and phase 2, respectively. The mean number of admission medication discrepancies decreased from 0.5 per patient in phase 1 to 0 per patient in phase 2. The mean number of discharge medication discrepancies decreased from 3.3 per patient in phase 1 to 1.8 per patient in phase 2. Conclusion. The mean number of medication discrepancies occurring during admission and discharge decreased after a multidisciplinary medication reconciliation process was implemented in an inpatient family medicine unit of an academic hospital center. Index terms: Documentation; Errors, medication; Hospitals; Prescriptions; Records

 

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