Ensuring seamless care

Medication reconciliation is important to patient safety and should be overseen by hospital pharmacists, but relatively few pharmacists have time to counsel patients before they are discharged, an exclusive Drug Topics survey of 640 health-system R.Ph.s found. Eighty-six percent of those who responded to the survey said medication reconciliation is extremely or very important to overall patient safety. Seventy-seven percent believe hospital pharmacies should oversee the reconciliation process, yet only 25% said pharmacists at their hospitals counsel patients on drug regimens before discharge.

"The survey shows that hospitals are still struggling with this," said Allen Vaida, Pharm.D., FASHP, executive VP of the Institute for Safe Medication Practices (ISMP). "They're all aware of the importance of it, but they're still struggling with it. I don't think anyone would disagree with that."

Policies vary

Hospitals have long strived to conduct medication reconciliation with patients to avoid such costly errors as drug omissions, duplications, improper dosing, and harmful drug interactions. Now required by the Joint Commission and endorsed by the Institute for Healthcare Improvement, medication reconciliation has become an important tool in the overall attempt to improve patient safety.

A report released by the Joint Commission in March on patient safety and hospital performance showed that nearly all the nation's accredited hospitals reconciled medications across the continuum of care in 2005. Accredited hospitals also passed along a list of patients' medications to the next healthcare provider or practitioner after discharge, the report concluded.

The Drug Topics survey revealed similar results. When health-system pharmacists were asked how closely employees follow their hospital's medication reconciliation policy, 94% replied "closely," "very closely," or "extremely closely." A total of 86% of respondents said their hospitals are doing a good, very good, or excellent job at reconciling medications.

"What you're finding in the survey is not much different from what the [Joint] Commission is seeing with compliance with the National Patient Safety Goals," said David Chen, director of ASHP's Pharmacy Practice section and director of the Section of Home, Ambulatory, and Chronic Care Practitioners. "This survey is good because it reflects the complexity of the issue and the way different groups are wrestling with the process."