Improving medication reconciliation in Robert Packer Hospital – A quality improvement project

From the 2018 HVPAA National Conference

Asish Regmi (Guthrie/Robert Packer hospital), John Pamula (Guthrie/Robert Packer hospital)


Medication reconciliation is the process of comparing a patient’s medication orders to all of the medications that the patient has been taking. It is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions.

Errors in medication reconciliation may lead to significant patient safety hazards.


To improve the current medication reconciliation process in Robert packer hospital mostly in patient with multiple medication in whom error occurs most.

To decrease the patient safety error due to medication error.

To make medical staff aware of different ways available for medication reconciliation


During the project period which extended from September to October 2017, 106 patient charts were reviewed. 50 patient charts were reviewed during pre-intervention period and 56 patient charts were reviewed during intervention period. Pre-intervention period was until September 18 and intervention period started after that. Only the patient admitted to two floors 6NW and 7M with 8 or more medication were included. Medication reconciliation done during the admission and discharge were reviewed. Then intervention was done. Multidisciplinary approach was applied. Nurses and residents were educated about different ways to do medication reconciliation. Flyers were distributed in the floor which showed different ways of doing reconciliation. Pharmacy was also involved in chart review and pointing out the errors. Then the charts of the patient admitted after my intervention were also reviewed for medication reconciliation error.


Of the 50-patient enrolled in pre- intervention period 35 patient had incomplete medication reconciliation. Discrepancies were present on 20 patient’s medication reconciliations. Most of the discrepancies were for dosing. Other discrepancies included duplicate medication, old medication not removed and important medication not resumed during admission. During post intervention of 56 patient 18 patient chart had incomplete medication reconciliation and discrepancies were present on 8 patient’s charts.Post intervention data showed improvement in both completeness of reconciliation process and no of discrepancies present.


Error and discrepancy do occur during medication reconciliation. Mostly occurs during transfer to floor from ICU or ER and on those patients who has multiple medication. Other discrepancies occur during admission from nursing home or discharge to the nursing home.

It is impossible to eliminate medication reconciliation error but some steps can be taken to reduce it. Change in EMR to be more user friendly, educating staff about ways of reconciliation and proper method to do it, patient and relatives education and an appointment of medication historian mostly from pharmacy background whose job will be medication reconciliation of the patient who comes to the hospital.

Implications for the Patient

By introducing the proper way of medication reconciliation among residents and nurses, it will decrease the number of medical error that is happening in hospitals.

Which will in turn decrease the medication related hazards, decrease the number of unwanted medication and disparity at different setting like home/nursing home and hospitals.

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