Medication Reconciliation Services Needed to Reduce Adverse Drug Events

Hospital Discharge

The need has never been greater for medication reconciliation especially during care transitions.

Poor communication at the transitions and interfaces of care account for about half of all hospital-related medication errors and 20 percent of all adverse drug events.

Adverse drug events are occurring at an alarming rate across all sectors of health care, proving to be a leading cause of death and injury among the patient population. The need has never been greater for medication reconciliation especially during care transitions.

Fueling the trend of adverse drug events are a fragmented care process and miscommunication between health care providers and patients. And the problem is getting worse.

Nearly 2 million people became ill or injured from medication side effects or because they took or were given the wrong type or dose of medication in 2008, compared with 1.2 million injured in 2004, according to the Agency for Healthcare Research and Quality.

The Joint Commission estimates that approximately 1.5 million preventable adverse drug events occur annually as a result of medication errors, at a cost of more than $3 billion per year.

Older people are especially vulnerable to medication errors due to the fact that they often have one or more chronic conditions requiring multiple prescription medications. In a study by the FDA that evaluated reports of fatal medication errors from 1993 to 1998, the most common error involving medications was related to administration of an improper dose of medicine, accounting for 41 percent of fatal medication errors. Giving the wrong drug and using the wrong route of administration each accounted for 16 percent of the errors. Almost half of the fatal medication errors occurred in people over the age of 60.

Medication reconciliation is a process of comparing medications being used by a client to a current list of prescribed medications to verify its accuracy, and is a best-practice strategy to reduce medication errors. Care transitions occur when a patient moves from one health care provider or setting to another. Nearly one in five Medicare patients discharged from a hospital—approximately 2.6 million seniors—is readmitted within 30 days, at a cost of over $26 billion every year, according to the Centers for Medicare & Medicaid Services.

Approximately half of all hospital-related medication errors and 20 percent of all adverse drug events have been attributed to poor communication at the transitions and interfaces of care, reports the Institute for Healthcare Improvement.

Health care settings that incorporate an effective medication reconciliation program have noticed improved results in medication management. In one study, medication reconciliation reduced discharge medication errors from 90 percent to 47 percent on a surgical unit and from 57 percent to 33 percent on a medical unit of a large academic medical center, according to the American Journal of Health-System Pharmacy.

In home healthcare, medication reconciliation includes comparing medications specified in hospital discharge instructions, those taken before the hospitalization, and those now taken by the client, and documenting action taken to resolve discrepancies noted.