Background: Medication errors are common, with more than half of patients estimated to have greater than or equal to one unintended medication discrepancy at hospital admission.  Medication reconciliation can identify errors. Although there has been significant investigation into the most effective logistical strategies for performing medicine reconciliation within the healthcare system, there is little investigation [...]

Background: Patients are discharged home on medications different than those they were taking before admission.  New and discontinued medications as well as dosage changes contribute to medication-related adverse events.  Purpose: To help address this problem, interns in our program developed a standard process during their quality improvement (QI) curriculum to ensure that at least 95% [...]

Background: Transitioning patient care between hospitals and skilled nursing facilities (SNFS) brings many challenges.  Patient and family anxiety, unfamiliarity and even misinformation about SNFs increase the opportunity for unsatisfactory outcomes and readmissions to the hospital..  Previous research has demonstrated frequent and potentially harmful medication discrepancies during hospital to nursing home transitions, and low frequency of [...]

Background: The Joint Commission (TJC) included medication reconciliation (MedRec) as a 2005 National Patient Safety Goal to reduce errors related to medication omissions, duplications and interactions. Medication errors and harms continue to be one of the most widely reported healthcare problems. TJC’s sentinel event database includes > 350 medication errors resulting in death or major [...]

Background: Obtaining the Best Possible Medication History (BPMH) is the protocolized gold standard in obtaining medication histories and well known to decrease the total number of medication errors during transitions in care. Trained technicians require an average of 15-30 minutes to collect a BPMH [2]. Our facility conducted a categorical analysis and within subject study [...]

Background: Medication reconciliation programs are a well-recognized important tool in reducing medication discrepancies and subsequently decreasing patient harm, particularly at transitions of care. Medication reconciliation programs have demonstrated error reductions upward of 66% [1-4]. 39% of prescription medication history errors have the potential to cause moderate or severe discomfort or deterioration in a patient’s condition [...]

Background: With growing importance placed on patient safety, it has become necessary to elevate past processes and rethink rolls for experienced healthcare professionals. One of the primary goals identified by The Joint Commission is to “maintain and communicate accurate patient medication information” to “safely prescribe medications in the future” [1]. This task is often complicated [...]

Background: Medication discrepancies are prevalent at various transitions of care including hospital discharge. Medication changes at hospital discharge may be misunderstood by the patient or not conveyed throughout the healthcare system. Most outpatient pharmacy medication records were created for the sole purpose of dispensing prescriptions. Pharmacists have little incentive to remove outdated medications and are [...]

Background: Communication related to medications is an important metric on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to measure patient experience after discharge from the hospital. There are many factors which can lead to poor communication about medications (Figure 1). Over 20% of readmissions can be related to medications, and of [...]

Background: Accurate, timely admission medication reconciliation (AMR) is a key patient-safety driver. Clinician-performed AMR has higher error rates compared to pharmacy-performed AMR. At our large, tertiary care institution, pharmacists capture only 75% of AMRs and require up to 48h for completion. Delays and errors in clinician-performed AMR on medicine floors have led to patient safety [...]