April 21, 2006

Medication Reconciliation Program

To help reduce the risk of medication errors, the MGH will be launching an electronic medication reconciliation process April 25 that will help clinicians track medication lists for both outpatients and inpatients. Medication reconciliation includes obtaining a complete list of medications that a patient is currently taking — including name, dosage, frequency and route — and comparing the admission, transfer and discharge orders for medications to that original list.

To make this documentation process more efficient for all clinicians, a centralized, easily accessible electronic version of the medication list will be available in Provider Order Entry (POE) beginning April 25 and will be introduced to inpatient units in stages. Called the Pre-Admission Medication List (PAML), this list of all prescription, over-the-counter and herbal medications taken by patients at home must be completed by the admitting or treating physician within 24 hours of admission.

"Ideally, the PAML would be created before the initial set of medication orders are entered into the POE system for all but emergency or urgent clinical situations," says Christopher Coley, MD, of MGH Internal Medicine. "This would allow the Pharmacy staff to perform the direct reconciliation of the PAML list with the admissions orders, looking carefully for potential differences that might indicate a potential medication error and then alerting the clinician to any concern."

A recurring message in POE will remind clinicians if the PAML is not completed within 24 hours. The treating clinician should work with other members of the nursing and pharmacy team to resolve any medication uncertainties during this time, which might mean contacting outside pharmacies or extended care facilities or asking families to bring in medication bottles from home. After the PAML has been created, any member of the care team may enter additional medication information. The PAML will be reviewed, verified and reconciled at various key points of the patient's care, such as before transfers or discharge.

"Creation of the PAML is a descriptive process, not just writing medication orders," says Coley. "Nonphysician members of the clinical care team will play an important
role in the development of the PAML, as new information about a patient's pre-admission medication history becomes available during the hospital stay."

For more information about the medication reconciliation initiative, contact Pat McCarthy at (617) 724-6771 or visit the Medication Education Safety & Approval Committee website at intranet.massgeneral.org/mesac/.