Pharmacists' medication reconciliation-related clinical interventions in a children's hospital.

Background: In response to experienced difficulties at Mayo Eugenio Litta Children's Hospital (Rochester, Minnesota) with medication reconciliation, the hospital developed and implemented a new medication reconciliation process.

Methods: In 2005, a multidisciplinary task force determined the need to improve accuracy of the admission medication list, define multidisciplinary responsibilities within the medication reconciliation process, develop a tool to readily identify patients in need of medication reconciliation, and allow for efficient documentation on completion of medication reconciliation activities. A patient-provided medication list was developed within the electronic medical record (EMR) to provide a common documentation tool for physicians, nurses, and pharmacists. Functionality was added to pharmacy's electronic pharmaceutical care Web-based program (PCARE) to alert pharmacists when a patient's admit medication history, admit medication reconciliation, or transfer medication reconciliation needs to be completed.

Results: From May 2006 to August 2007, the pediatric pharmacists performed admission medication reconciliation on 85% of the patients within 24 hours and completed transfer reconciliation on all the patients-an average of 13 admitted and 11 transfer patients a day. They documented 567 medication reconciliation-related interventions during the May 2006 through the August 2007 period; 522 (92%) occurred during admission medication reconciliation and the remaining 46 (8%) during transfer reconciliation; 505 (89%) led to a change in therapy.

Discussion: Pharmacists' medication reconciliation-related clinical interventions indicate that the time and effort of performing medication reconciliation activities results in benefits for patients.