[Medication Reconciliation-theory and practice].

Area of Science:

• Patient Safety
• Health Informatics
• Clinical Pharmacy

Context:

• The World Health Organization's High5s project targets reducing serious patient safety events.
• Medication reconciliation is a key intervention for improving patient safety at care transitions.
• Eleven German hospitals are implementing medication reconciliation.

Purpose:

• To systematically implement and evaluate medication reconciliation in German hospitals.
• To reduce medication discrepancies during transitions of care.
• To ensure medication accuracy and optimize drug treatment for patients.

Summary:

• Medication reconciliation involves three steps: obtaining a comprehensive medication history, physician prescribing based on this history, and comparing the history with admission orders.
• Discrepancies identified during reconciliation are clarified with the responsible physician.
• Accurate medication history is crucial and integrated into patient records for ongoing care adjustment.

Impact:

• Successful implementation can lead to significant reductions in medication errors, with studies showing up to 90% prevention of unintentional discrepancies.
• A German hospital reported a 77% reduction in discrepancies through medication reconciliation.
• Further studies are investigating the impact of medication reconciliation on clinical endpoints.