Definitions, responsibilities are crucial to medication reconciliation

Dec 14 2012

By Sarah Guy, medwireNews Reporter

To implement effective medication reconciliation, a definition of what the term means, as well as identification of who is responsible for the process, is necessary, show the results of a focus group-based study.

The responses of the physicians, pharmacists, and nurse practitioners who took part indicate that acknowledging the limitations of information technology and the contribution of each role to medication reconciliation is critical.

"Medication reconciliation is more than just matching medication lists when patients transition among hospitals, personal residences, nursing homes and other health care settings," said co-author Amy Vogelsmeier (University of Missouri, Columbia, USA) in a media release.

"It's an opportunity to ask whether medications are still appropriate and consistent with the patients' therapeutic goals, and then to make adjustments to their regimens if needed," she added.

Vogelsmeier and colleagues' focus groups, held in 2008 to 2009 and involving 13 physicians, 16 pharmacists, and 19 nurses working at one of three healthcare institutions, revealed some opinions indicating a "narrow scope" for medication reconciliation.

One registered nurse explained the process as simply checking a patients' "master list" of medications against the "bag of meds" brought to the hospital at admission.

By contrast, pharmacists were more likely to emphasize the importance of knowing what patients are taking and why, which the study researchers put down to a "heightened focus on patient and medication safety."

Some of each of the professions believed that computerized lists currently in practice are "often inaccurate and unreliable," especially in cases where patients receive care from multiple providers.

Low health literacy and nonadherence also emerged as a theme preventing effective medication reconciliation, and while physicians and nurses recognized the potential threat to patient safety, they "rarely" associated these risks with the reconciliation process, note the researchers.

Participants viewed pharmacists as particularly key to the information flow around medications, write Vogelsmeier and team in Research in Social and Administrative Pharmacy.

"Physicians are ultimately accountable for assuring patients' medication therapy is appropriate, but pharmacists play critical roles because of their in-depth knowledge of medication management and their focus on safety," Vogelsmeier said.

She emphasized the importance of a "joint effort," explaining that "nurses are the ones who identify and communicate what patients are really taking home because of their proximity to patients and their families."

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