Development and Evaluation of a Hospital Medication Reconciliation Process: A Case Study for Diabetic In – patient Service at a Mid - level General Hospital in the Northeast Region

Abstract

Introductions: Medication errors (ME) can commonly occur in a part of the care transitions process in hospitals. The effective  medication reconciliation (MR) process can protect around half of the medication errors before harm. The objectives of this research were, firstly, to analyze the current situation and problems involved in the MR process for proposing further process improvement, and secondly, to evaluate the outcomes after implementing the newly proposed MR process. Materials and Method: Data collection included document analysis, in-depth interviews, focus group discussion with key stakeholders, and evaluate the outcome newly proposed MR process of the hospital admission and discharge process at the in-patient ward among patients with diabetes mellitus. Results: The results showed that most healthcare providers understood the MR concept but they were not aware of how important it was to communicate or document in the in-patient chart when any medication change. In fact, they viewed the MR process as a burden and suggested to lessen the process by applying some information technology. Moreover, there was a lack of involvement from the patients and their families’ contribution toward the MR process. After the newly MR process had been revised and implemented, the number of patients who were assessed MR process increased from 16.67% to 74.4% and 81.76% respectively. Unintentional discrepancy at admission process decreased from 2.08% to 0.17% and 0.15% respectively. The MR success index increased from 0.5% to 0.72% and 0.66%, respectively. The net cost saving of medicine from MR process increased from 2,844 Baht to 10,376.62 Baht and 11,883.33 Baht after the post-intervention period. Conclusion: The newly developed MR process had remarkably improved the MR process, which can reduce ME before harm occur and increase medicine cost saving.