Medication reconciliation in hospice: a pilot study

Area of Science:

• Pharmacology
• Patient Safety
• Geriatric Care

Background:

• The Joint Commission mandated medication reconciliation processes by January 2006.
• Medication reconciliation involves obtaining accurate medication histories during care transitions.
• Inaccurate histories increase the potential for medication errors.

Purpose of the Study:

• To determine the prevalence of medication reconciliation errors in hospice care.
• To assess the impact of medication reconciliation on patient safety in a hospice setting.

Main Methods:

• Patients were enrolled from two hospices in Maryland in January 2007.
• Nurses completed an initial medication history upon hospice admission.
• Pharmacists conducted a second medication history within five days and identified discrepancies.

Main Results:

• A total of 504 medication discrepancies were identified.
• Medication omissions were the most frequent type of error.
• Every patient had at least one discrepancy, averaging 8.7 per patient.
• 190 drug interactions were found, many of moderate severity.

Conclusions:

• Terminally ill patients often have complex medication regimens, heightening error risks.
• Implementing accurate medication histories is essential for error reduction and minimizing patient harm.