Medication Safety: Taking and Reconciling Patients' Medications
Reconciling medications ensures every patient admitted to BWH has a medication history recorded and reviewed with the patient and/or caregiver. This information should be accessible to all clinical staff who have a direct role in the care and welfare of patients. The medication history should be referenced and subsequently cross-checked when a responsible clinician writes admission, transfer and discharge orders, and communicated to the next provider of service when the clinician refers or transfers the patient to another setting, service, practitioner or level of care within or outside the organization. This process is part of a comprehensive strategy to optimize medication safety, achieved in collaboration with the patient's physicians, nurses and pharmacists.
BWH recognizes that, despite the best efforts, the collection of pre-admission medication history data is inherently subject to error. Staff should recognize that the process is a "best attempt" to capture the medications the patient is taking, as well as highlight and document discrepancies or uncertainties between what the patient's providers recommend and what the patient is taking. Because the history data may be imperfect, clinicians who care for the patient should inform other team members about any inaccuracies they find.
BWH is participating in a Partners-wide medication reconciliation process that uses an electronic capture of a patient's medication history for the clinician to first verify with the patient and then reconcile the list with unprescribed medications upon admission, transfer and discharge. BWH is conducting pilots in January and February and intends to roll out a working process in May. The intent of the new process is to increase accuracy, but physicians and nurses should be taking medication histories and performing medication reconciliation as part of their practice.