Impact of a Pharmacist-conducted Admission Medication Reconciliation Program on Medication Errors

Purpose: The purpose of this study was to (1) determine the medication error rate identified upon admission medication reconciliation; (2) describe the error type, proximal cause, and potential severity, and; (3) determine the time allocated in conducting medication reconciliation.

Methods: This was a single-center, concurrent study conducted at a major teaching medical institution. Following IRB approval, data collection was conducted over a 4-week period (August 22, 2011 to September 16, 2011). Descriptive statistical methods were performed for all data analysis.

Results: A total of 517 patients involving 5006 medications were included in this study. Over 25% (n=132) of patients had ≥1 error associated with a medication prescribed upon hospital admission, which was resolved through pharmacist intervention. Pharmacists resolved a total 467 admission medication errors, which translated into 3.5 ± 2.3 (mean ± SD) medication errors per patient. The most common type of medication error resolved by the pharmacist upon hospital admission was medication omission (79.6%) followed by wrong dose (12.6%) and wrong frequency (4.3%). In regards to severity, 46% of medication errors were considered significant or serious. Overall, the mean (± SD) total time was 44.4 ± 21.8 minutes per medication reconciliation.

Conclusion: A significant number of medication errors were identified and resolved by pharmacist intervention during the admission medication reconciliation process. Pharmacist involvement in the admission medication reconciliation process demonstrated significant improvement in patient safety.