 Preventing Adverse Reactions and Errors through Medication Reconciliation
If you work with renal patients, you may well have run into medication mix-ups, for instance where a prescriber’s medication order isn’t clear or seems to conflict with a previous order. At best, such a situation can take a number of phone calls and a great deal of time to clear up. At worst, medication errors can result in serious consequences for patients.
Here’s where medication reconciliation comes in - a process designed to bring more clarity and precision to medication orders. Good communication about medications among caregivers and with patients is considered so critical, it’s now required as an organizational practice by the Canadian Council on Health Services Accreditation (see sidebar). Hospitals are starting to implement medication reconciliation as a key measure for meeting the accreditation standard – and of course to improve patient safety.
Medication reconciliation demands keeping an accurate and current medication list for every patient. All members of a patient’s health care team should be involved in this process: wherever a medication list is kept, the "keeper" – including the patient – should ensure it is up to date. The need for strong communications in this situation – especially when updates or changes may occur frequently – is critical. Ideally, the patient’s pharmacist will hold the master list, and would be consulted in the event of discrepancies.
One example of where discrepancies may occur, and when patients are particularly vulnerable to medication errors, is at key transition points in their care (e.g. admission to and discharge from hospital, and transfer within hospital). For renal patients, the medication reconciliation process helps prevent medication errors by:
- Ensuring that an accurate list of all the patient’s home and dialysis medications is kept up to date;
- Reminding renal team members and patients to refer to that list whenever new medication orders are written;
- Standardizing a process for checking the list against the physician’s admission, transfer, and/or discharge orders. This process will identify discrepancies and bring them to the attention of the physician for necessary changes.
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