Implementing a sustainable medication reconciliation process in Australian hospitals: The World Health Organization High 5s project.

BackgroundMedication reconciliation (medrec) is a mandated patient safety strategy by national, including Australian, accreditation bodies. Yet there are no validated performance measures.ObjectiveTo determine the feasibility of implementing the World Health Organization (WHO) Medrec Standard Operating Protocol (SOP) in a range of Australian acute care facilities to achieve measurable and sustainable reductions in medication discrepancies occurring at admission.MethodsA multicentre, prospective national study was conducted in ten academic, urban and regional hospitals to implement the SOP using WHO High 5s project and quality improvement methodology. Sites collected data on the rate of medrec performed within 24 h of admission in a random selection of 50 patients aged ≥65 years admitted via the emergency department, monthly for four years. Medrec quality was reviewed in a subset of 30 patients using three performance measures. Barriers, enablers and benefits of SOP implementation were collected using qualitative surveys.ResultsTen health services reviewed 42,003 patient records. Of these, 20,162 (49.5%) had medicines reconciled within 24 h of admission. Four services increased, two decreased, and in four, medrec completion rates remained static. Mean number of unintentional and undocumented intentional medication discrepancies per patient decreased: 0.21 to 0.16 (p = 0.001) and 0.34 to 0.08 (p = 0.003), respectively. Unintentional discrepancies decreased from 15.2% to 11.1% (p = 0.001). Barriers to full implementation included: medrec not seen as a priority, limited resources and lack of electronic systems integration. Enablers included: use of medrec measures for feedback, educational resources, and 7-day week clinical pharmacy services. Benefits included improvements in medication safety culture and multidisciplinary teamwork.ConclusionsThe WHO SOP was feasible, although challenging, to implement in a range of acute health services, and produced measureable and sustainable improvements in medicines information accuracy on admission. Sustaining the quantum of quality and timely medrec requires investment in pharmacist resources and electronic systems integration

Reducing dose omission of prescribed medications in the hospital setting: a narrative review

© 2016, Springer International Publishing Switzerland.Medication error, including dose omission of prescribed medications, can lead to adverse outcomes for hospital patients. Consequently, there is an onus on healthcare staff to understand the causes of these errors and introduce proven methods to prevent their recurrence. This paper presents a review of the literature on the reported causes of, and suggested solutions to, omitted administration of prescribed medications in hospital inpatient settings. Dose omission of prescribed medication has been shown to be one of the commonest causes of medication error in inpatient populations. Unavailable medication, poor communication and poor documentation of administered medications are commonly cited explanations. Institutions have implemented strategies, which have been shown to reduce the incidence of omissions. Such strategies include changing pharmacy processes to ensure medication is available when required; introducing electronic prescribing; encouraging improved communication between healthcare professionals involved in medication management; and educating staff about the importance of administering all prescribed medications, documenting when medications are administered and reporting all medication omissions