Reducing medication errors and improving systems reliability using an electronic medication reconciliation system.

Background: Medication reconciliation (MedRecon) has been a Joint Commission National Patient Safety Goal since 2006. However, there is scant literature on the evaluation of electronic MedRecon systems in reducing medication errors and on improving reliability of the MedRecon process.

Methods: An electronic MedRecon system was designed and implemented in an acute inpatient care facility. Two analyses were performed: (1) one based on a 2-week pilot evaluation of the system based on 120 MedRecon events, and (2) a more comprehensive 17-month evaluation of the system, based on 19,356 MedRecon events.

Results: The unintended discrepancy rate between a patient's home medications and admission medication orders was reduced from 20% during the pilot phase to 1.4%. The omission of a home medication was the most common type of discrepancy. Nighttime admission (8 P.M.-8 A.M.), total home medications > four, patient age > 65 years, and resident physician performing the medication reconciliation were found to have a significant positive correlation (p < .05) with the discrepancy rate. Using computerized alerts improved compliance with the MedRecon process from 34% to 98%-100%.

Discussion: Using a multidisciplinary process based on an electronic system substantially reduced medication errors on admission, suggesting that an electronic MedRecon system can be an important tool in improving patient safety. The use of an interactive reminder alert in the MedRecon system improved systems reliability by ensuring physician compliance with MedRecon performance. Although computerized physician order entry (CPOE) decision support tools are an important component of medication error prevention strategies, they alone are not sufficient to prevent errors of prescribing.