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How reliable are patient-completed medication reconciliation forms compared with pharmacy lists?
Carolyn Meyer1, Michael Stern, Wendy Woolley
1Albany Medical Center, Albany, NY 12208, USA.
Objectives:
Medication reconciliation is a Joint Commission for the Accreditation of Healthcare Organizations requirement to reduce medication errors. This study evaluated the reliability of patient-completed medication reconciliation forms (MRs) compared with pharmacy-generated lists and determined if there was a difference in concordance when patients completed the forms from memory compared with when they brought a separate list or pill bottles.
Methods:
We prospectively enrolled patients with completed MRs. Research assistants contacted the patient's pharmacy to determine medications filled in the prior 3 months, which was compared with the MR. Discrepancies and the method by which the patient completed the MR (memory, list, or pill bottles) were recorded.
Results:
Three hundred fifteen patients were enrolled. Thirty-three percent made errors of omission (reported by pharmacy, but not on MR), 12.7% made errors of addition (reported on MR, but not by pharmacy), 18.1% made both types of errors, and 36.3% made no errors. Patients with errors were on 5.6 medications compared with 3.6 medications for those without errors (P < .0001). Those completing the MR from a list made 2.3 errors compared with 1.2 for those completing from memory and 1.8 for those completing from their pill bottles (P < .001). Of 390 medications omitted from patient lists, 16% were cardiac medications, 13% were neuropsychiatric agents, and 9.5% were narcotics.
Conclusions:
Thirty-six percent of patients were able to provide a medication list that matched their pharmacy-prescribed drugs. More errors were noted from patients taking more medications and from those completing their MR from a separate list.
Insights
Patient medication reconciliation forms (MRs) are often unreliable, with over half of patients making errors. Accuracy decreases with more medications and when patients use a separate list instead of memory.
Area of Science:
- Healthcare quality improvement
- Patient safety
- Medication management
Background:
- Medication reconciliation is a Joint Commission requirement to reduce medication errors.
- Patient-completed forms are a common method for medication reconciliation.
Purpose of the Study:
- To evaluate the reliability of patient-completed medication reconciliation forms (MRs).
- To compare MR accuracy against pharmacy-generated medication lists.
- To determine if completing MRs from memory, a list, or pill bottles affects accuracy.
Main Methods:
- Prospective enrollment of patients with completed MRs.
- Pharmacy records were used to verify medications filled in the prior 3 months.
- Discrepancies and completion method (memory, list, pill bottles) were recorded.
Main Results:
- 36.3% of patients had no errors; 33% had omissions, 12.7% had additions, and 18.1% had both.
- Patients with errors were on more medications (5.6 vs. 3.6).
- Completing MRs from a list resulted in more errors (2.3) than from memory (1.2) or pill bottles (1.8).
Conclusions:
- Only 36% of patients accurately completed their medication lists.
- Increased medication errors are associated with a higher number of medications and using a separate list for reconciliation.
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