Improving medication reconciliation in the 21st century

Area of Science:

• Health Informatics
• Patient Safety
• Pharmacology

Background:

• Medication errors cause significant mortality and morbidity annually in the US.
• Computerized order entry systems demonstrate effectiveness in reducing inpatient medication errors.
• The adoption of electronic medical records (EMRs) is advocated for both inpatient and outpatient settings.

Purpose of the Study:

• To evaluate the evidence for electronic medical records reducing adverse drug events in the outpatient setting.
• To identify barriers to realizing the safety benefits of health information technology in outpatient care.

Main Methods:

• Review of existing evidence on the impact of EMRs on adverse drug events.
• Analysis of medication list accuracy in complex outpatient populations.

Main Results:

• Limited evidence suggests EMRs do not significantly reduce outpatient adverse drug events.
• Medication list accuracy is poor, with only 5% agreement between lists and actual patient regimens in complicated cases.
• The quality of medication lists is a major impediment to safety.

Conclusions:

• Improved medication reconciliation is essential for leveraging health information technology for patient safety.
• Accurate medication lists require a dedicated healthcare team effort for acquisition and maintenance.