Patient safety is the priority of the healthcare system as a whole and any given medical facility in particular. Medicine reconciliation is a pivotal element of patient safety that ensures eliminating medication prescription errors and minimizes risks for harmful effects. The problem identified in the worksite is that the hospital staff does not properly follow the requirements for timely addressing of patients’ medicine reconciliation. The risks of harm to patients’ health or even death are high due to the lack of well-defined protocol for medication reconciliation that would necessitate non-complicated access to patients’ medication history records by all involved parties, include the patients. Therefore, immediate action is recommended to implement strategies for effective medication reconciliation practices in the facility.
Failure to Address Patients Medicine Reconciliation in a Timely Manner
The issue of concern is the lack of timely addressing of patient medication reconciliation by doctors of the hospital. In contemporary medical practice, evidence proves that the knowledge about patients’ history of medicine intake should be obtained through the Best Possible Medication History (BPMH) procedure (World Health Organization [WHO], n. d.). However, several constraining factors obstruct accurate and timely clarification of the information and present drugs that should guide the procedures of prescription to the patient when he or she is admitted, transferred, or discharged. The factors include the high level of patient load, understaffing of the facility, the lack of effective electronic means of medication reconciliation results dissemination, and no strict medicine reconciliation protocol in place
The Importance of the Issue of Concern
The importance of patient medication reconciliation practices in the healthcare setting has been continuously emphasized and cannot be overestimated. The life and safety of patients depend on the accuracy, competence, and timeliness of the reconciliation procedures. Indeed, according to the data provided by the WHO (n. d.), “sixty-seven percent of patients’ medication histories have one or more errors15 and up to 46% of medication errors occur during prescription at patient admission or discharge” (p. 4). Indeed, one of the leading causes of morbidity and mortality in the hospital setting is due to adverse drug events.
They commonly occur because of inadequate reconciliation practices and miscommunication between units, professionals, and physicians, and their patients. Most commonly (approximately 50% of all cases), medication management errors happen “on admission or discharge from a clinical unit or hospital, and around 30% of these errors have the potential to cause patient harm” (WHO, n. d., p. 4). Therefore, patient outcomes strongly depend on the appropriate addressing of the patient medication reconciliation by doctors in a timely manner, which emphasizes the importance of the issue.
A number of observed situations and reported cases have been identified as evidence supporting the tentativeness of the issue of the failure to address patient medicine reconciliation on time. Firstly, patients in transition care do not obtain necessary medication reconciliation procedures, which causes misunderstanding between the hospital units and uninformed decision-making of physicians. Indeed, the physicians repeatedly fail to communicate patient medication history effectively when a patient is transferred from one ward to another. This occurs due to the lack of a well-functioning unified electronic system of patient medication record dissemination across all units of the facility.
Secondly, several instances of the delayed medication reconciliation interviews with patients were detected that led to patients’ complications due to the prescription of incompatible drugs. Due to the postponed interview concerning past and present drugs patients had been prescribed, the administration of new medications in the hospital led to the disruption of care and harm caused to patients. As a result, the number of complaints has increased, and some reputation and cost losses have been experienced. Thirdly, doctors have repeatedly failed to clarify the medication history with patients who were admitted to the hospital in critical conditions that did not allow them to report their medication history.
The lack of efforts to contact family members in a timely manner caused several problematic occurrences with critical patients when admitted to the intensive care unit. Finally, there were cases when doctors conducted medication reconciliation procedures on admission, discontinued previously prescribed drug for the duration of hospitalization to avoid drug incompatibility consequences, but then failed to re-prescribe the medication upon discharge. Such a large number of disruptions increases risks to patient safety and indicates the ineffectiveness of the current medication reconciliation policy.
Consequences of Taking No Action
In case of continuous occurrence of the identified cases when BPMH is not obtained on time, the performance of the hospital staff will be disrupted. Significant reputation losses might follow since the patients tend to complain more often. In addition, high costs are added to the expenses of the facility of managing the outcomes of poor addressing of patient medication reconciliation. The additional treatment and interventions that are needed after an incidence of adverse drug events might lead to non-planned losses and might hinder the efficiency of the facility’s functioning. Most importantly, it is vital to maintain the hospital’s capability to provide high-quality, competent care by means of advanced protocols aimed at facilitating the implementation of medicine reconciliation.
Given the acute attention of the contemporary healthcare circles to the importance of patient medicine reconciliation, several recommendations might be designed based on the WHO guidelines. Firstly, the analysis of errors should be conducted to detect the most common problematic issues and their causes. The identified results of the analysis should be integrated into the newly designed and updated policies to maintain patient safety by eliminating the causes of errors. Secondly, it is recommended that the principle highlighting that “a formal structured process for reconciling medications should be in place cross all interfaces of care” should be prioritized (WHO, n. d., p. 7).
It should be used as a basis for designing a strict protocol that would guide the medication-related actions of doctors at the facility. Thirdly, a well-written updated instruction to guide the staff across the medication history referencing at all times, especially when patients are admitted, transferred, or discharged. It is essential to include the guidelines for contacting family members to clarify the medication history of patients incapable of reporting such information themselves.
Fourthly, the electronic patient record should be updated to ensure accurate and adequate addressing of patient medicine reconciliation. The data on the patient should be accessible to all involved parties across the facility to minimize the risks for maltreatment when a patient is transferred from one ward to another. Fifthly, an effective training session should be initiated to educate the staff on the importance of timely patient medication reconciliation and the correct way of using a new protocol, and updates of the electronic data on medication history. Hopefully, these measures will help eliminate the problematic issue and improve the quality of care.
The World Health Organization. (n. d.). Standard operating protocol: Assuring medication accuracy at transitions in care. Web.