I can’t recall when medication reconciliation was first introduced in healthcare but it has to be around for at least 10 years or so. But sadly, I still get asked why we have to do it, why we can’t have a check box to resume the previous orders when an individual is transferred back to our facility.
If we are asking such a question, we are not understanding the importance of medication reconciliation.
Medication reconciliation is a process to obtain the best possible medication history which should be done at any point of transfer in care. These include admissions to a new facility (e.g. hospital), transfers between different units within a facility and / or discharges from a hospital or other facilities.
So why we invest in time, energy or resources to implement such a process which may be labour intensive?
That’s because medication incidents occur most often during the transition of care and this can be minimized by completing a medication reconciliation. It’s time consuming but it forces us to look closely at the individual’s medications and ensure that all medications ordered are appropriate. If there are any discrepancies or uncertainties, they are identified and clarified in a timely manner.
Medication changes occur all the time in a health care setting. It is an important part of providing quality care to patients – new medication get started with a new diagnosis, doses adjusted due to renal or hepatic impairment, medications are discontinued due to adverse effects or they are no longer needed. But when too many changes are happening, we also need a dedicated process to help reconcile changes and that is exactly why we need to do medication reconciliation.
So when nurses and doctors are frustrated with medication reconciliation, there are primarily two reasons:
- The first reason is that perhaps the current process is inefficient. Systemically, we may want to review the process and assess if there are ways to streamline steps, put tools or resources in place to support team members who will be performing medication reconciliations.
- The second reason is the resistance due to the lack of understanding. To fix this requires a reset of the organization’s culture. If we are complaining because we spend too much time talking, clarifying about medication discrepancies, then we are not realizing its importance in preventing medication incidents that ultimately prevent harm.
Primum non nocere – First, do no harm. That’s precisely why we need to do med reconciliation.
For more information on medication reconciliation, I encourage you to visit the ISMP Canada or click here to view the many tools and resources to support medication reconciliation.