Current medication reconciliation practices miss the mark

A comprehensive list of correct medications will take more work than the current reconciliation process.

To do medication reconciliation right, providers should aim for a “correct” medication list, according to a recent op-ed.

Despite the recent focus on medication reconciliation as a quality metric, the process as currently practiced has not significantly improved patient outcomes, wrote Adam J. Rose, M.D., Shira H. Fischer, M.D., Ph.D., and Michael K. Paasche-Orlow, M.D., in JAMA.

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To achieve a list of correct medications for a patient, they recommend undertaking several rounds of reconciliation beyond the typical comparison of a patient’s medication lists at admission and discharge.

The ideal process would involve several metrics, including:

  • Coordinating among clinicians to ensure all providers involved in a patient’s care have the same list of medications, and that they agree that the medications on the list are all appropriate. Sufficient interoperability among clinicians’ electronic medical record programs can make this a challenge, the authors note.
  • Involving the patient. Patient-centric medication plans boost adherence by ensuring patients receive the lowest effective dose at a frequency they can tolerate. The authors also point out that it makes no sense to keep medications on a list if a patient refuses to take it.
  • Understanding that sometimes less is more. Making a decision to deprescribe a medication can improve patient safety by pruning medications that may have outlived their usefulness or may never have been appropriate at all. This extends to unaffordable medications as well, which the article notes may be difficult information for clinicians to obtain.

The authors note that establishing a more comprehensive system will require “appropriate delegation, implementation of relevant information technology, creating systems to support the work to maintain a list, and developing payment mechanisms and performance measures.”

Nevertheless, they believe the development of a correct medication list for all patients would significantly improve the odds of better healthcare outcomes, in part by helping to reduce medication-related errors.