Improvement and Evaluation of Medication Reconciliation at Orthopedic Wards in a Regional Hospital

Abstract

Objective: To improve and evaluate medication reconciliation (MR) at orthopedic wards of a regional hospital. Method: This study was an action research with document review to analyze the problems within MR system. An in-depth group discussion among 11 multidisciplinary health personnel involving to MR process stakeholders to determine how to improve the system, and to set indicators and goals. This led to the preparation of operating tools and guidelines for MR. The study evaluated results of MR in patients with chronic non-communicable diseases admitted to orthopedic wards after system improvement. (April-June 2022) Results: The MR process in the old system lacked adequate communication, and no establishment of criteria and specific function of each multidisciplinary team members. Existing performance indicator on drug related problems cannot be used to prevent medication errors (ME) when patients were transferred. This led to the need to improve the MR system by changing pharmacist's search procedure for medication history, the indication of drug allergy history using the color of prescription, the use of reminder sticker for drug review, monitoring and recording of MR results in pharmacist’s note and electronic database. After improving the MR system, 162 visits (88.0% of 184 hospital visits) underwent MR within 24 hours after admission and 179 (97.3%) underwent MR at hospital discharge, which was greater than the target (80%). The problems on insufficient amount of drugs for use up to next visit were corrected in all hospital visits. The study found a discrepancy between newly prescribed medicines and those currently taking by the patients in 17.1% and 6.2% of the number of prescription drugs prescribed while hospitalized during hospital admission and discharge, respectively. 27.4% of discrepancies, considered as ME, were unintended by physicians and could not be explained by clinical reasons. MEs were identified in 20.1% of hospital visits. The most common ME was patients not receiving medication they were taking. The majority of ME severity was B. Physicians accepted by 88.6% of the recommendations from pharmacists to prevent or reduce ME. Conclusion: Improving the MR system by enhancing inter-professional communication, streamlining operating procedures and the development of operational tools led to the identification of MEs caused by medication discrepancies, helped prevent drug related problems and enabled patients to receive continuous care.