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Pharmacists' Medication Reconciliation–Related Clinical Interventions in a Children's Hospital

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Background: In response to experienced difficulties at Mayo Eugenio Litta Children's Hospital (Rochester, Minnesota) with medication reconciliation, the hospital developed and implemented a new medication reconciliation process.

Methods: In 2005, a multidisciplinary task force determined the need to improve accuracy of the admission medication list, define multidisciplinary responsibilities within the medication reconciliation process, develop a tool to readily identify patients in need of medication reconciliation, and allow for efficient documentation on completion of medication reconciliation activities. A patient-provided medication list was developed within the electronic medical record (EMR) to provide a common documentation tool for physicians, nurses, and pharmacists. Functionality was added to pharmacy's electronic pharmaceutical care Web-based program (PCARE) to alert pharmacists when a patient's admit medication history, admit medication reconciliation, or transfer medication reconciliation needs to be completed.

Results: From May 2006 to August 2007, the pediatric pharmacists performed admission medication reconciliation on 85% of the patients within 24 hours and completed transfer reconciliation on all the patients—an average of 13 admitted and 11 transfer patients a day. They documented 567 medication reconciliation–related interventions during the May 2006 through the August 2007 period; 522 (92%) occurred during admission medication reconciliation and the remaining 46 (8%) during transfer reconciliation; 505 (89%) led to a change in therapy.

Discussion: Pharmacists' medication reconciliation–related clinical interventions indicate that the time and effort of performing medication reconciliation activities results in benefits for patients.

Document Type: Research Article

Publication date: May 1, 2009

More about this publication?
  • Published monthly, The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. The Joint Commission Journal on Quality and Patient Safety invites original manuscripts on the development, adaptation, and/or implementation of innovative thinking, strategies, and practices in improving quality and safety in health care. Case studies, program or project reports, reports of new methodologies or new applications of methodologies, research studies on the effectiveness of improvement interventions, and commentaries on issues and practices are all considered.

    Also known as Joint Commission Journal on Quality Improvement and Joint Commission Journal on Quality and Safety
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