Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2013

Open Access 01-12-2013 | Research article

Medication reconciliation at admission and discharge: a time and motion study

Authors: Ari N Meguerditchian, Stanimira Krotneva, Kristen Reidel, Allen Huang, Robyn Tamblyn

Published in: BMC Health Services Research | Issue 1/2013

Login to get access

Abstract

Background

Medication reconciliation at admission, transfer and discharge has been designated as a required hospital practice to reduce adverse drug events. However, implementation challenges have resulted in poor hospital adherence. The aim of this study was to assess the processes required to carry out medication reconciliation: the health professionals involved, the tasks and time devoted to medication reconciliation in general hospital settings.

Methods

A time-and-motion study design was used. Using a systematic sample of patients admitted and discharged from geriatric, medical and surgical units in two academic centers, health professionals involved in medication reconciliation were observed and timed. Descriptive statistics were used to summarize the number of professionals involved, tasks performed, and mean time devoted.

Results

Up to 3 professionals from 2 disciplines (medicine and pharmacy) were involved in the medication reconciliation process. Geriatric reconciliations took the most time to complete at admission (mean: 92.2 minutes (SD = 44.3)) and discharge (mean: 29.0 minutes (SD = 23.8)), followed by internal medicine at admission (mean: 46.2 minutes (SD = 21.1)) and 19.4 (SD = 11.7) minutes at discharge) and general surgery minutes at discharge (mean: 9.9 minutes (SD = 18.2)). Considerable differences in order, type and number of tasks performed were noted between and within units. Tasks independent of direct patient interaction took more than twice the time required to complete than tasks requiring patient interaction.

Conclusion

Lack of coordination, specialized training and agreement on the roles and responsibilities of professionals are among the most probable reasons for work-flow inefficiencies, possibly variability in quality, and time required for the current medication reconciliation process. A better understanding of the admission processes in general surgery is required. Standardization and use of electronic tools could improve efficiency and hospital adherence.
Literature
1.
Lazarou J, Pomeranz BH, Corey PN: Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998, 279 (15): 1200-1205. 10.1001/jama.279.15.1200.CrossRefPubMed
2.
Bates DW, Spell N, Cullen DJ, Burdick E, Laird N, Petersen LA, Small SD, Sweitzer BJ, Leape LL: The costs of adverse drug events in hospitalized patients. Adverse drug events prevention study group. JAMA. 1997, 277 (4): 307-311. 10.1001/jama.1997.03540280045032.CrossRefPubMed
3.
Forster AJ, Clark HD, Menard A, Dupuis N, Chernish R, Chandok N, Khan A, Van Walraven C: Adverse events among medical patients after discharge from hospital. Can Med Assoc J. 2004, 170 (3): 345-349.
4.
Leape LL, Bates DW, Cullen DJ, Cooper J, Demonaco HJ, Gallivan T, Hallisey R, Ives J, Laird N, Laffel G: Systems analysis of adverse drug events. JAMA. 1995, 274 (1): 35-10.1001/jama.1995.03530010049034.CrossRefPubMed
5.
LaPointe NMA, Jollis JG: Medication errors in hospitalized cardiovascular patients. Arch Intern Med. 2003, 163 (12): 1461-10.1001/archinte.163.12.1461.CrossRefPubMed
6.
Cornish PL, Knowles SR, Marchesano R, Tam V, Shadowitz S, Juurlink DN, Etchells EE: Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005, 165 (4): 424-10.1001/archinte.165.4.424.CrossRefPubMed
7.
Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R, Etchells EE: Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. Can Med Assoc J. 2005, 173 (5): 510-515. 10.1503/cmaj.045311.CrossRef
8.
Mersfelder TL, Bickel RJ: Inpatient medication history verification by pharmacy students. Am J Health Syst Pharm. 2008, 65 (23): 2273-2275. 10.2146/ajhp080013.CrossRefPubMed
9.
Pippins JR, Gandhi TK, Hamann C, Ndumele CD, Labonville SA, Diedrichsen EK, Carty MG, Karson AS, Bhan I, Coley CM: Classifying and predicting errors of inpatient medication reconciliation. J Gen Intern Med. 2008, 23 (9): 1414-1422. 10.1007/s11606-008-0687-9.CrossRefPubMedPubMedCentral
10.
Rozich JDRRK: Medication safety: One Organization’s approach to the challenge. J Clin Outcomes Manag. 2001, 8 (10): 8.
11.
Pronovost P, Weast B, Schwarz M, Wyskiel RM, Prow D, Milanovich SN, Berenholtz S, Dorman T, Lipsett P: Medication reconciliation: a practical tool to reduce the risk of medication errors. J Crit Care. 2003, 18 (4): 201-10.1016/j.jcrc.2003.10.001.CrossRefPubMed
12.
Whittington J, Cohen H: OSF healthcare's journey in patient safety. Qual Manag Health Care. 2004, 13 (1): 53-59. 10.1097/00019514-200401000-00005.CrossRefPubMed
13.
Rozich JD, Howard RJ, Justeson JM, Macken PD, Lindsay MF, Resar RK: Standardization as a mechanism to improve safety in health care. Jt Comm J Qual Patient Saf. 2004, 30 (1): 5-14.
14.
van den Bemt PMLA, van den Broek S, van Nunen AK, Harbers J, Lenderink AW: Medication reconciliation performed by pharmacy technicians at the time of preoperative screening. Ann Pharmacother. 2009, 43 (5): 868-874. 10.1345/aph.1L579.CrossRefPubMed
15.
16.
17.
Paparella S: Medication reconciliation: doing what's right for safe patient care. J Emerg Nurs. 2006, 32 (6): 516-520. 10.1016/j.jen.2006.07.003.CrossRefPubMed
18.
Coffey M, Cornish P, Koonthanam T, Etchells E, Matlow A: Implementation of admission medication reconciliation at two academic health sciences centres: challenges and success factors. Healthc Q. 2009, 12: 102-109. 10.12927/hcq.2009.20719.CrossRefPubMed
19.
20.
Miller SL, Miller S, Balon J, Helling TS: Medication reconciliation in a rural trauma population. Ann Emerg Med. 2008, 52 (5): 483-491. 10.1016/j.annemergmed.2008.03.021.CrossRefPubMed
21.
Karapinar-Carkit F, Borgsteede SD, Zoer J, Smit HJ, Egberts AC, van den Bemt PM: Effect of medication reconciliation with and without patient counseling on the number of pharmaceutical interventions among patients discharged from the hospital. Ann Pharmacother. 2009, 43 (6): 1001-1010. 10.1345/aph.1L597.CrossRefPubMed
22.
Chevalier BA, Parker DS, MacKinnon NJ, Sketris I: Nurses' perceptions of medication safety and medication reconciliation practices. Nurs Leadersh (Tor Ont). 2006, 19 (3): 61-72. 10.12927/cjnl.2006.18369.CrossRef
23.
Barnsteiner JH: Medication Reconciliation Patient Safety and Quality. 2008, Rockville MD: An Evidence-Based Handbook for Nurses
24.
Hummel J, Evans PC, Lee H: Medication reconciliation in the emergency department: opportunities for workflow redesign. Qual Saf Health Care. 2010, 19 (6): 531-535. 10.1136/qshc.2009.035121.PubMed
25.
Schenkel S: The unexpected challenges of accurate medication reconciliation. Ann Emerg Med. 2008, 52 (5): 493-495. 10.1016/j.annemergmed.2008.07.026.CrossRefPubMed
26.
Pronovost P, Weast B, Schwarz M, Wyskiel RM, Prow D, Milanovich SN, Berenholtz S, Dorman T, Lipsett P: Medication reconciliation: a practical tool to reduce the risk of medication errors. J Crit Care. 2003, 18 (4): 201-205. 10.1016/j.jcrc.2003.10.001.CrossRefPubMed
27.
Vira T, Colquhoun M, Etchells E: Reconcilable differences: correcting medication errors at hospital admission and discharge. Qual Saf Health Care. 2006, 15 (2): 122-126. 10.1136/qshc.2005.015347.CrossRefPubMedPubMedCentral
28.
Sullivan C, Gleason KM, Rooney D, Groszek JM, Barnard C: Medication reconciliation in the acute care setting: opportunity and challenge for nursing. J Nurs Care Qual. 2005, 20 (2): 95-98. 10.1097/00001786-200504000-00001.CrossRefPubMed
29.
30.
Brannick MT, Levine EL, Morgeson FP: Job and work analysis: Methods, research, and applications for human resource management. 2007, Sage Publications, Incorporated
31.
Reeder TA, Mutnick A: Pharmacist-versus physician-obtained medication histories. Am J Health Syst Pharm. 2008, 65 (9): 857-860. 10.2146/ajhp070292.CrossRefPubMed
32.
Lizer MH, Brackbill ML: Medication history reconciliation by pharmacists in an inpatient behavioral health unit. Am J Health Syst Pharm. 2007, 64 (10): 1087-1091. 10.2146/ajhp060323.CrossRefPubMed
33.
Barnsteiner JH: Medication reconciliation: transfer of medication information across settings—keeping it free from error. J Infus Nurs. 2005, 28 (2 suppl): 31-6.CrossRefPubMed
34.
Steurbaut S, Leemans L, Leysen T, De Baere E, Cornu P, Mets T, Dupont AG: Medication history reconciliation by clinical pharmacists in elderly inpatients admitted from home or a nursing home. Ann Pharmacother. 2010, 44 (10): 1596-1603. 10.1345/aph.1P192.CrossRefPubMed
35.
Bails D, Clayton K, Roy K, Cantor MN: Implementing online medication reconciliation at a large academic medical center. Jt Comm J Qual Patient Saf. 2008, 34 (9): 499-508.PubMed
36.
Clay BJ, Halasyamani L, Stucky ER, Greenwald JL, Williams MV: Results of a medication reconciliation survey from the 2006 Society of Hospital Medicine national meeting. J Hosp Med. 2008, 3 (6): 465-472. 10.1002/jhm.370.CrossRefPubMed
37.
Mueller SK, Cunningham SK, Kripalani S, Schnipper JL: Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012, 172 (14): 1057-1069. 10.1001/archinternmed.2012.2246.CrossRefPubMedPubMedCentral
38.
Greenwald JL, Halasyamani L, Greene J, LaCivita C, Stucky E, Benjamin B, Reid W, Griffin FA, Vaida AJ, Williams MV: Making inpatient medication reconciliation patient centered, clinically relevant and implementable: a consensus statement on key principles and necessary first steps. J Hosp Med. 2010, 5 (8): 477-485. 10.1002/jhm.849.CrossRefPubMed
39.
Cornu P, Steurbaut S, Leysen T, De Baere E, Ligneel C, Mets T, Dupont AG: Effect of medication reconciliation at hospital admission on medication discrepancies during hospitalization and at discharge for geriatric patients. Ann Pharmacother. 2012, 46 (4): 484-494. 10.1345/aph.1Q594.CrossRefPubMed
40.
Schnipper JL, Hamann C, Ndumele CD, Liang CL, Carty MG, Karson AS, Bhan I, Coley CM, Poon E, Turchin A, et al: Effect of an electronic medication reconciliation application and process redesign on potential adverse drug events: a cluster-randomized trial. Arch Intern Med. 2009, 169 (8): 771-780. 10.1001/archinternmed.2009.51.CrossRefPubMed
41.
Turchin A, Hamann C, Schnipper JL, Graydon-Baker E, Millar SG, McCarthy PC, Coley CM, Gandhi TK, Broverman CA: Evaluation of an inpatient computerized medication reconciliation system. J Am Med Inform Assoc. 2008, 15 (4): 449-452. 10.1197/jamia.M2561.CrossRefPubMedPubMedCentral
42.
Kramer JS, Hopkins PJ, Rosendale JC, Garrelts JC, Hale LDS, Nester TM, Cochran P, Eidem LA, Haneke RD: Implementation of an electronic system for medication reconciliation. Am J Health Syst Pharm. 2007, 64 (4): 404-422. 10.2146/ajhp060506.CrossRefPubMed
43.
Poon EG, Blumenfeld B, Hamann C, Turchin A, Graydon-Baker E, McCarthy PC, Poikonen J, Mar P, Schnipper JL, Hallisey RK: Design and implementation of an application and associated services to support interdisciplinary medication reconciliation efforts at an integrated healthcare delivery network. J Am Med Inform Assoc. 2006, 13 (6): 581-592. 10.1197/jamia.M2142.CrossRefPubMedPubMedCentral
44.
Lesselroth BJ, Felder RS, Adams SM, Cauthers PD, Dorr DA, Wong GJ, Douglas DM: Design and implementation of a medication reconciliation kiosk: the Automated Patient History Intake Device (APHID). J Am Med Inform Assoc. 2009, 16 (3): 300-304. 10.1197/jamia.M2642.CrossRefPubMedPubMedCentral
45.
Simon SR, Smith DH, Feldstein AC, Perrin N, Yang X, Zhou Y, Platt R, Soumerai SB: Computerized prescribing alerts and group academic detailing to reduce the use of potentially inappropriate medications in older people. J Am Geriatr Soc. 2006, 54 (6): 963-968. 10.1111/j.1532-5415.2006.00734.x.CrossRefPubMed
46.
Tamblyn R, Huang A, Kawasumi Y, Bartlett G, Grad R, Jacques A, Dawes M, Abrahamowicz M, Perreault R, Taylor L: The development and evaluation of an integrated electronic prescribing and drug management system for primary care. J Am Med Inform Assoc. 2006, 13 (2): 148-159. 10.1197/jamia.M1887.CrossRefPubMedPubMedCentral
47.
Tamblyn R, Huang A, Perreault R, Jacques A, Roy D, Hanley J, McLeod P, Laprise R: The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care. Can Med Assoc J. 2003, 169 (6): 549-556.
48.
Tamblyn R, Huang AR, Merguerditchian AN, Winslade NE, Rochefort C, Buckeridge D, Jacques A, Naicker K, Reidel KE, Eguale T: Using novel Canadian resources to improve medication reconciliation at discharge: study protocol for a randomized controlled trial. Trials. 2012, 13 (1): 150-10.1186/1745-6215-13-150.CrossRefPubMedPubMedCentral
49.
Adair JG: The hawthorne effect: a reconsideration of the methodological artifact. J Appl Psychol. 1984, 69 (2): 334.CrossRef
Metadata
Title
Medication reconciliation at admission and discharge: a time and motion study
Authors
Ari N Meguerditchian
Stanimira Krotneva
Kristen Reidel
Allen Huang
Robyn Tamblyn
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2013
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-13-485

Other articles of this Issue 1/2013

BMC Health Services Research 1/2013 Go to the issue

Research article

Effect of private insurance incentive policy reforms on trends in coronary revascularisation procedures in the private and public health sectors in Western Australia: a cohort study

Research article

Sexual reproductive health service provision to young people in Kenya; health service providers’ experiences

Study protocol

Effectiveness of a new health care organization model in primary care for chronic cardiovascular disease patients based on a multifactorial intervention: the PROPRESE randomized controlled trial

Research article

The role of the healthcare sector in the prevention of sexual violence against sub-Saharan transmigrants in Morocco: a study of knowledge, attitudes and practices of healthcare workers

Research article

Social inequalities in patient experiences with general practice and in access to specialists: the population-based HUNT Study

Study protocol

Case management and self-management support for frequent users with chronic disease in primary care: a pragmatic randomized controlled trial