The Importance of Medication Reconciliation in Patient Care Transitions
In this digital, tech-enabled world, clinicians across the care continuum still rely on patients to self-report their current and previous medications. Given that one-third of Americans take five or more prescription drugs, medication histories often get spotty, leading to potentially dangerous outcomes.
Accurate and up-to-date medication reconciliation is a constant challenge in both acute and post-acute settings. Medication reconciliation is the process of comparing a patient’s new medication orders with all the other medications the patient had been taking prior to changes in level of care.
Each year, there are about 1.5 million adverse drug events (ADEs) caused by medication errors such as improper dosage, incorrect delivery route, or the wrong medication all together. These medication errors lead to nearly 700,000 emergency department visits and 100,000 hospitalizations each year.
With increasing demands on both patients and providers, it’s not surprising that the problem has grown in recent years. Many patients struggle to remember their medications, while busy doctors are pressed for time during appointments. Yet, doctors and nurses need to know the exact medication details for each patient in order to avoid ADEs and deliver high quality care.
Recognizing this opportunity for improvement, CMS implemented the Meaningful Use Incentive Program in 2011 to encourage the use of EHR technology to improve patient quality, safety and outcomes. In 2015, it updated the rules to require that providers sending patients to another facility give the new providers an electronic record of that patient’s care. This new rule shifted the process of medication reconciliation, along with other care processes, from voluntary and manual to compulsory and automated.
CMS labeled continuity of care documents (CCDs) as a “candidate standard” format of these care records. As a result, CMS forced the process of obtaining more accurate medication history into the 21st century. Almost like taking a still photo of a patient in time, CCDs capture critical details about medication regimens—details that patients are unlikely to remember. CCDs thus have been instrumental in helping providers depend less on patients’ self-reported medical histories.
While these new regulations have helped make advances toward better care outcomes, the use of CCDs can still be improved. CCDs pull from a variety of sources that require complex patient matching and record settling. For the most accurate and appropriate care needs, CCDs need to be able to pull from real-time data. It is simply not effective to pull data from last month’s or even last week’s medication records. Patients, whose health situations and prescriptions can change quickly, check into facilities with immediate needs. And immediate needs require immediate information.
Still, the use of real-time data in conjunction with CCDs only aids, rather than replaces, the human touch. About half of the medication errors in hospitals and 20% of ADEs are due to poor communication in care transitions. The New Jersey Hospital Association tackled this issue by implementing a quality improvement program based on networks of doctors working together and sharing data, tools and insights. As a result, the biggest area of outcome improvement was in ADEs, which saw a 55% decrease in the program’s first four years. In addition, the savings from the 55% decrease totaled $9.4 million.
The success of NJHA shows that medication reconciliation has to go beyond pill boxes and CCDs. The data should become the common ground for providers to discuss and collaborate on appropriate care plans. While patients may still be asked to bring in their pill boxes for good measure, providers can use hard data to protect patient safety and inform their cooperative care plan decisions.