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A study published in the Journal of Hospital Medicine found that 29 minutes of data-gathering by the nurse to create a home medication list and then comparing it with the active inpatient medications averted 81 adverse drug events in 290 patients (Feldman, 2012).
The IHI defines medication reconciliation as:
“…the process of creating the most accurate
list possible of all medications a patient is taking - including drug name, dosage, frequency, and route - and comparing that list against the physician’s admission, transfer, and/or discharge orders, with the goal of providing correct medications to the patient at all transition points within the hospital.”
This is largely a nursing task, as nurses implement discharge teaching and planning. Instead of assuming the next provider will take care of it, incorporate it into your nursing care.
Think ahead: As a nurse practitioner, med reconciliation is key to providing safe patient care.
Medication management for elderly patients in an academic primary care setting: A quality improvement project
The effects of taking multiple medications concurrently to manage coexisting health problems, such as diabetes and hypertension.
The National Coordinating Council for Medication Error Reporting and Prevention (2014) defines a medication error as:
"...any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer."
Approximately 11% of the nurse’s medication administration time is spent dealing with distractions and interruptions.
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Bower, R., Jackson, C., & Manning, J. C. (2015). Interruptions and medication administration in critical care. Nursing in critical care, 20(4), 183-195.
Carayon P., Wetterneck J., Cartmill R., Blosky M., Brown R., Kim R., … Walker J. (2014). Characterizing the complexity of medication safety using a human factors approach: an observational study in two intensive care units. BMJ Quality and Safety, 11 (319), 56-65.
Chhabra, P.T., Rattinger, G.B., Dutcher, S.K., Hare, M.E., Parsons, K.L., &Zuckerman, I.H. (2012). Medication reconciliation during the transition to and from long-term care settings: A systematic review. Research in Social and Administrative Pharmacy, 8, 60-75. doi: 10.1016/j.sapharm.2010.12.002
de Vries, E. N.; Ramrattan, M. A., Smorenburg, S.M., Gouma, D. J., Boermeester, M. A. (2008). The incidence and nature of in-hospital adverse events: a systematic review [Abstract]. Quality and Safety in Health Care, 17, 216–23.
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Hanlon, J.T., Semla, T. P., Schmader,K.E. (2014). Medication misadventures in older adults literature from 2013, Journal of the American Geriatric Society, 62 (10), 1950-1953.
Feldman, L. S. (2012). Nurse-pharmacist collaboration on medication reconciliation prevents potential harm. Journal of Hospital Medicine, 7(5), 396-401.
Kaufmann, J., Laschat, M., & Wappler, F. (2012). Medication errors in pediatric emergencies: a systematic analysis. Deutsches Ärzteblatt international, 109(38), 609.
Kaufman, G. (2015). Multiple medicines: the issues surrounding polypharmacy. Nursing and Residential Care, 17 (4), 198-203.
Levinson, D.R., (2010). Adverse events in hospitals: national incidence among medicare beneficiaries. Office of Inspector General, Department of Health and Human Services, 2010.
McComas J., Riingen M., Kim, S. C. (2014). Medication administration record on medication administration efficiency and e rrors. CIN: Computers, Informatics, Nursing, 32 (12), 589–595.
National Coordinating Council for Medication Error Reporting and Prevention. About medica- tion errors. (2014). Retreived from http://www.nccmerp.org/aboutMedErrors.html. http://www.ihi.org/topics/adesmedicationreconciliation/Pages/default.aspx
Patterson, S.M., Hughes, C., Kerse, N., Cardwell, C.R., Bradley, M.C. (2012) Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Systematic Review, 16 (5). doi: 10.1002/14651858.CD008165.pub2.
Pasina, L., Brucato, A.L., Falcone, C., Cucchi, E., Bresciani, A., Sottocorno, M., Taddei, G.C., Casati, M., Franchi, C., Djade, C.D., Nobili, A. (2014). Medication non-adherence among elderly patients newly discharged and receiving polypharmacy. Drugs and Aging 31 (4) 283-289.
Preyde, M., Brassard, K. (2011). Evidence-based risk factors for adverse health outcomes in older patients after discharge home and assessment tools: a systematic review, Journal of Evidence Based Social Work. 8 (5) 445-468. doi: 10.1080/15433714.2011.542330
Rinke, M. L., Bundy, D. G., Velasquez, C. A., Rao, S., Zerhouni, Y., Lobner, K., ... & Miller, M. R. (2014). Interventions to reduce pediatric medication errors: a systematic review. Pediatrics, 134(2) 338-360.
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Vejar, M.V., Flynn Makic, M.B., Kotthoff-Burrell, E. (2013) Medication management for elderly patients in an academic primary care setting: A quality improvement project, Journal of the American Association of Nurse Practitioners doi: 10.1002/2327-6924.12121
Williams, T., King, M. W., Thompson, J. A., & Champagne, M. T. (2014). Implementing Evidence-Based Medication Safety Interventions on a Progressive Care Unit. AJN The American Journal of Nursing, 114(11), 53-62.
Wu, H. F., Yu, S., Lan, Y. H., & Tang, F. I. (2012). Medication errors in emergency rooms, intensive care units and pediatric wards. Hu Li Za Zhi, 59(2), 93.