Medication Reconciliation

Medication Reconciliation

There is a specific purpose behind every prescribed drug. Still, each drug requires context: a decision on medication needs to be based on the overall picture of the patient. This story is about the pharmaceutical picture.

Medication reconciliation (med rec) is the formal process of identifying all medications a patient is taking—and using that list to provide him or her with correct medications at each transition of care. At its heart, med rec keeps patients safe, reducing complications and side effects. Staying organized in this way can take a bite out of the $2.6 billion annual price tag for drug-related hospitalizations.

Last November, a unique report on med rec emerged that painted a broad-stroke picture. Accreditation Canada led the project—with partners CIHI, the Canadian Patient Safety Institute and the Institute for Safe Medication Practices Canada—to illustrate how proper communication around medications fosters safer care.

Managing Multiple Medications
CIHI data helped show that med rec is key to preventing patient safety incidents. Specifically, med rec can reduce emergency department visits as well as the number of Canadians readmitted to hospitals. In 2010, for instance, more than 180,000 patients returned to hospital within a month. By preventing drug interactions and side effects, med rec helps keep patients out of the hospital.

That is especially prudent for the 6.8 million Canadians with such ambulatory care sensitive conditions as asthma, chronic obstructive pulmonary disease, diabetes, hypertension and heart diseases. CIHI data shows that 58% of patients with at least one such condition reviewed their drugs with their family physician, while 40% said their medications were not well managed.

Then there are the aging baby boomers. Already, seniors take more drugs—and four times as many over-the-counter products—than anyone else. The value of proper medication management is clear when you consider that 63% of seniors take at least 5 drugs and 23% take at least 10. One-quarter of Canadian seniors use medications to treat three or more conditions.

We’re Getting Better
While the issue is coming to the forefront, and studies show that med rec is effective, Jonathan Mitchell of Accreditation Canada said that there are key opportunities for improvement.

“It’s clear that rates of medication reconciliation have increased in past years,” Mitchell said. “Considerable progress has been achieved, yet med rec remains one of the lowest rates of compliance among the Accreditation Canada Required Organizational Practices.”

Still, med rec across Canadian organizations rose to 77% in 2011 from 61% in 2010. On the front lines, compliance rates of med rec at admission rose to 60% from 47% over the same period, and med rec at transfer or discharge climbed to 50% from 36%.

Important Alliance
This joint report, a first, was from four organizations that possess different data. Mitchell said it was valuable in showcasing different perspectives on the issue and, most of all, shining light on med rec.

So where do we go from here? Resources are in place to help push med rec further and make it a priority from coast to coast. As part of a National Medication Reconciliation Strategy, a curriculum for health care practitioners is being developed, along with tools, resources and technology supports.

Check out, for example, this interactive map of innovative med rec resources across Canada. And since med rec is everyone’s responsibility, patients included, there is a new app for iPhones and iPads. MyMedRec, launched in 2012, permits Canadians to manage medications safely and appropriately.

Wherever patients transition in the health care spectrum, their current list of drugs should transition right along with them.