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Medication Reconciliation Practices and Potential Clinical Impact of Unintentional Discrepancies

Medication Reconciliation Practices and Potential Clinical Impact of Unintentional Discrepancies We read with interest the excellent article by Mueller and colleagues1 about hospital-based medication reconciliation practices. We would like to offer some elements about our own experience. The evaluation of the potential clinical impact of the unintentional discrepancies identified and corrected during medication reconciliation process is particularly of high interest. Recently, we have set up conciliation at admission within our hospital and estimated in parallel the potential clinical significance of identified unintentional discrepancies by using a 3-category scale: level 1, “no potential harm”; level 2, “monitoring or intervention potentially required to preclude harm”; and level 3, “potential harm.” On the basis of 256 patients, our results showed that 27.2% of the identified unintentional discrepancies (n = 173) were judged to be of clinical importance, indicating that they had the potential to cause patient harm (level 3, 6.4%) or the potential to require a greater patient supervision (level 2, 21.8%). Potential harm was driven by the type of errors (eg, omission, incorrect medication prescription), by the type of medication classes and the number of medications per patient, and by the clinical characteristics of the patients. We also performed a systematic search of English-language articles about the rating of potential harm during reconciliation and identified 15 articles published between 2005 and 2012. These studies estimated that 14.7%2 to 66.2%3 of unintentional discrepancies at admission or discharge were able to cause potential damage to patients. This wide range in results is partially because of the use of different methods for scoring medication errors. Nevertheless, all of the studies confirm that medication discrepancies have the potential to cause deterioration in patients' clinical status and encourage pharmacists and clinicians to identify the most effective practices to avoid them across the continuum of care. Back to top Article Information Correspondence: Dr Michel, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Pôle Pharmacie-Pharmacologie, Service de Pharmacie, 1 Ave Molière BP 83 049, 67098 Strasbourg CEDEX, France (bruno.michel@chru-strasbourg.fr). Conflict of Interest Disclosures: None reported. References 1. Mueller SK, Sponsler KC, Kripalani S, Schnipper JL. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012;172(14):1057-106922733210PubMedGoogle ScholarCrossref 2. Vira T, Colquhoun M, Etchells E. Reconcilable differences: correcting medication errors at hospital admission and discharge. Qual Saf Health Care. 2006;15(2):122-12616585113PubMedGoogle ScholarCrossref 3. Kwan Y, Fernandes OA, Nagge JJ, et al. Pharmacist medication assessments in a surgical preadmission clinic. Arch Intern Med. 2007;167(10):1034-104017533206PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Internal Medicine American Medical Association

Medication Reconciliation Practices and Potential Clinical Impact of Unintentional Discrepancies

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References (3)

Publisher
American Medical Association
Copyright
Copyright © 2013 American Medical Association. All Rights Reserved.
ISSN
2168-6106
eISSN
2168-6114
DOI
10.1001/jamainternmed.2013.1235
Publisher site
See Article on Publisher Site

Abstract

We read with interest the excellent article by Mueller and colleagues1 about hospital-based medication reconciliation practices. We would like to offer some elements about our own experience. The evaluation of the potential clinical impact of the unintentional discrepancies identified and corrected during medication reconciliation process is particularly of high interest. Recently, we have set up conciliation at admission within our hospital and estimated in parallel the potential clinical significance of identified unintentional discrepancies by using a 3-category scale: level 1, “no potential harm”; level 2, “monitoring or intervention potentially required to preclude harm”; and level 3, “potential harm.” On the basis of 256 patients, our results showed that 27.2% of the identified unintentional discrepancies (n = 173) were judged to be of clinical importance, indicating that they had the potential to cause patient harm (level 3, 6.4%) or the potential to require a greater patient supervision (level 2, 21.8%). Potential harm was driven by the type of errors (eg, omission, incorrect medication prescription), by the type of medication classes and the number of medications per patient, and by the clinical characteristics of the patients. We also performed a systematic search of English-language articles about the rating of potential harm during reconciliation and identified 15 articles published between 2005 and 2012. These studies estimated that 14.7%2 to 66.2%3 of unintentional discrepancies at admission or discharge were able to cause potential damage to patients. This wide range in results is partially because of the use of different methods for scoring medication errors. Nevertheless, all of the studies confirm that medication discrepancies have the potential to cause deterioration in patients' clinical status and encourage pharmacists and clinicians to identify the most effective practices to avoid them across the continuum of care. Back to top Article Information Correspondence: Dr Michel, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Pôle Pharmacie-Pharmacologie, Service de Pharmacie, 1 Ave Molière BP 83 049, 67098 Strasbourg CEDEX, France (bruno.michel@chru-strasbourg.fr). Conflict of Interest Disclosures: None reported. References 1. Mueller SK, Sponsler KC, Kripalani S, Schnipper JL. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012;172(14):1057-106922733210PubMedGoogle ScholarCrossref 2. Vira T, Colquhoun M, Etchells E. Reconcilable differences: correcting medication errors at hospital admission and discharge. Qual Saf Health Care. 2006;15(2):122-12616585113PubMedGoogle ScholarCrossref 3. Kwan Y, Fernandes OA, Nagge JJ, et al. Pharmacist medication assessments in a surgical preadmission clinic. Arch Intern Med. 2007;167(10):1034-104017533206PubMedGoogle ScholarCrossref

Journal

JAMA Internal MedicineAmerican Medical Association

Published: Feb 11, 2013

Keywords: medication reconciliation

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