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Medication reconciliation: a practical tool to reduce the risk of medication errors
Peter Pronovost1, Brad Weast, Mandalyn Schwarz
1Department of Anesthesiology and Critical Care Medicine Surgery and Health Policy and Management, The Johns Hopkins University, Baltimore, MD 21231, USA. ppronovo@jhmi.edu
Journal of Critical Care
|December 24, 2003
Summary
Implementing a discharge survey as part of medication reconciliation significantly reduced medication errors for intensive care unit (ICU) patients. This process improved patient safety during hospital discharge.
Area of Science:
- Medical Safety
- Clinical Pharmacy
- Patient Care
Background:
- Preventable adverse drug events contribute to significant patient injury and mortality.
- Medication errors frequently occur during transitions of care, such as hospital admission and discharge.
Purpose of the Study:
- To decrease medication errors in patient discharge orders within an adult surgical intensive care unit (ICU).
- To evaluate the effectiveness of a medication reconciliation process incorporating a discharge survey.
Main Methods:
- A discharge survey was integrated into the medication reconciliation process.
- Admitting nurses initiated surveys within 24 hours of ICU admission; charge nurses completed them at discharge.
- Baseline data involved reviewing medical/anesthesia records and verifying home medications for 10% of discharges.
Main Results:
- Baseline data indicated that 94% of patients had changes to their discharge orders.
- Following implementation of the survey and reconciliation process, medication errors in discharge orders were nearly eliminated by week 24.
- The process led to a substantial reduction in medication errors for ICU patients.
Conclusions:
- Utilizing a discharge survey within a medication reconciliation framework dramatically reduced medication errors in ICU discharges.
- The successful survey is now a standard part of electronic medical records across multiple ICUs and medicine floors.