Experience from hundreds of organizations has shown that poor communication of medical information at transition points is responsible for as many as 50 percent of all medication errors in the hospital and up to 20 percent of adverse drug events (ADEs). Each time a patient moves from one setting to another, clinicians should compare previous medication orders with new orders and plans for care and reconcile any differences. If this process does not occur in a standardized manner designed to ensure complete reconciliation, medication errors may lead to adverse events and harm.
Organizations can evaluate how well their own processes work by collecting data on the percentage of unreconciled medications. Teams should measure the percentage of unreconciled medications to see if the changes they are testing and implementing in reconciliation processes are leading to improvement.
The numerator is the number of unreconciled medications (note that this is medications, not doses). If a medication is omitted in the orders without explanation, it is unreconciled, so your evaluation should not be based on orders alone. For example, if a medication is omitted, check the progress notes for a documented reason; if a legitimate reason for not ordering the medication is found, such as the patient is toxic from too much of the drug, then it would be considered reconciled.
The denominator is the total number of medications ordered for patients in the sample. This would include all medications ordered previously (e.g., from home medication list or MAR prior to transfer or discharge) and all medications ordered at transition (admitting or transfer orders or discharge instructions) in the reviewed sample of charts. Note: Over-the-counter (OTC) and herbal medications are not to be counted in the denominator when first starting this process. The recommended approach is to reconcile prescription medications first and once a good process is in place, then add OTC, herbals and other medications.
Reduce the percent of unreconciled medications in your area of focus (admission, transfer, or discharge) by 75 percent (or to zero). It is anticipated that each organization will ultimately address all three areas related to reconciliation (admission, transfer, and discharge). It is best to start with admission reconciliation.
Data Collection Plan
Summarize and report monthly.