Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:The Culture of Health Care
Unit:Sociotechnical Aspects: Clinicians and Technology
Lecture:Medical errors
Patient safety
Slide content:Medication Reconciliation Continued Methods for medication reconciliation: Audit process across the medication ordering, fulfilment, and administration Link process to computerized physician order entry (CPOE) and medication administration record (MAR) Integrate medication reconciliation in the CPOE, pharmacy systems, MARs, and EHRs, Have patients instead of clinicians reconcile their medications Studies suggest reduction in errors but have not yet demonstrated improvement in outcomes 17
Slide notes:Many different methods have been suggested for medication reconciliation to reduce medication errors. One method in the inpatient setting supports reconciliation of the physicians medication orders with the pharmacys medication fulfilment and the patients medication administration record and EHR utilized by nursing staff. While medication is administrated by nursing staff and processed by the pharmacy department, physicians, physician assistants, and nurse practitioners with prescribing privileges are licensed to order or prescribe patient medications. Another method links the medication reconciliation process to computerized physician order entry, or CPOE. An additional information system included in the reconciliation process is the medication administration record (MAR), which is part of the patients legal medical record. The MAR is used by clinicians to document all drugs administered to a patient during his or her treatment at a provider. MARs are used by all providers and may vary slightly based on the needs of the specific provider type. Electronic versions may be called e-MARs. A third method integrates medication reconciliation into the user interface as a function of the patients EHR and MAR. Information systems provide the opportunity to utilize alerts and alarms from medication prescribing to fulfilling the order to medication administration to the patient. Information systems are tools clinicians can use to support medication administration and management while preventing unnecessary errors. Yet another suggestion is that the onus of medication reconciliation should be removed from clinicians and put in the hands of patients themselves; in other words, patients, not clinicians, should reconcile their medications. The increasing role of patient and family engagement in the patients care may advance this suggestion over time. Evidence suggests that medication reconciliation reduces errors. Ongoing research will hopefully prove that error reduction drives improved outcomes and increased patient satisfaction. 17