Article by Kimberly Hume, MSN, RN, FAHCEP and Elizabeth Tomsik, PharmD, BCPS, PMC

“Like patient education, effective approaches to medication reconciliation can get lost among the myriad of duties performed by pharmacists and clinicians. The unfortunate reality is that transitions from one health care setting to another substantially increase the risk of ADEs due to unintentional changes in patient medication regimens.

Research reveals that unintended medication discrepancies occur in nearly one-third of patients, both at the time of admission and during transfer from one unit of a hospital to another. Another 14% of these discrepancies occur at discharge. When a patient’s complete medication regimen is reviewed at the time of admission, transfer, and discharge and then compared with the medications being considered for a new setting, the potential for ADEs – and subsequently readmissions – can be minimized. Thus, the ability to gather a complete preadmission medication list at the time of admission and provide a patient with a medication list at the time of discharge is imperative to medication reconciliation. Drug reference tools can play a key role in the process of checking or revising medication information to ensure proper dosing and confirm that the correct medication information is provided.”

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Our Transition of care program, IMPACT™ (Integrated Management for Post Acute Care Transitions), is designed to reduce hospital readmissions.

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