Nurse-pharmacist collaboration on medication reconciliation prevents potential harm

Area of Science:

• Healthcare quality improvement
• Patient safety research
• Clinical pharmacy practice

Background:

• Medication reconciliation is crucial for preventing adverse drug events (ADEs).
• A prospective study evaluated a replicable nurse-pharmacist led process for ADE prevention.
• The focus was on efficiency and cost-effectiveness.

Purpose of the Study:

• To assess the efficiency and cost-effectiveness of a nurse-pharmacist led medication reconciliation program.
• To determine the frequency of potentially harmful medication discrepancies.
• To evaluate the impact on patient safety.

Main Methods:

• Nurses created home medication lists (HML) via patient interviews and record reviews.
• HMLs were compared to inpatient medication orders to identify discrepancies.
• Discrepancies were categorized as intentional or unintentional and rated for potential harm.

Main Results:

• 40% of 563 patients had unintended discrepancies at admission or discharge.
• 162 patients had high-harm (2-3 scale) unintended discrepancies.
• The cost per identified potentially harmful discrepancy was $113.64, averting 81 ADEs per 290 patients.

Conclusions:

• Frequent, potentially harmful medication discrepancies occur at admission and discharge.
• Nurse-pharmacist collaboration effectively reconciled discrepancies, preventing harm.
• The process is efficient, cost-effective, and enhances patient safety.