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SUZANNE B. WORTMAN, B.S., PHARM.D., BCPS, is Clinical Pharmacy Specialist, DuBois Regional Medical Center, 100 Hospital Avenue, DuBois, PA 15801 (sbwortman{at}drmc.org).

Purpose. A medication reconciliation program involving physicians, pharmacists, nursing staff, and other personnel at a community hospital is examined. Summary. The Joint Commission required hospitals to have a procedure in place for reconciling patient medication across the continuum of care by January 1, 2006. A multidisciplinary team was formed to address reconciliation of medications at DuBois Regional Medical Center. Baseline data on the number of medications unreconciled at admission, transfer, and discharge were collected. A reconciliation process and policy were developed and implemented. The pilot program took place on a nursing unit with a select group of physicians who were known leaders, who had a substantial patient volume, and who showed an interest in the program. Letters were sent to physicians to outline the opportunities of the program. The letters encouraged physicians to participate and cited advantages such as decreased legibility issues, less opportunity for transcription error, improvement in accuracy, convenience, and time saved by using electronically generated lists instead of lists written by hand. Continuous audits, feedback, and education provided an ongoing assessment of the benefit of the program in terms of reduction of unreconciled medications and highlighted opportunities for improvement. In June 2005, baseline statistics of unreconciled medications at admission and discharge were 15% and 18%, respectively. Following implementation of the program, numbers fluctuated but improved. During the second half of 2007, the percentages of unreconciled medications on admission and at discharge were less than 10% and continued the trend downward to less than 5%. Conclusion. A community hospital has instituted a medication reconciliation program that involves physicians, pharmacists, nursing staff, and other personnel. Audits, feedback, and education are key components in the program’s operation and improvement. Index terms: Errors, medication; Health professions; Hospitals; Quality assurance