The Impact of Delayed Medication Reconciliation for Patients Admitted to the General Internal Medicine Service at St. Joseph’s Healthcare Hamilton - A Retrospective Study

Abstract

Medication reconciliation is an accreditation standard that identifies discrepancies between a patient’s home and admission medications. Completing medication reconciliation within 48 hours of admission is a policy at St. Joseph Healthcare Hamilton (SJHH). Prioritization is given to General Internal Medicine (GIM) patients over age 65 and the target completion rate is 100%. The aim of this study was to assess GIM medication reconciliation performance at SJHH and to evaluate the impact of delaying medication reconciliation. The objective is to determine the number of medication reconciliations completed within 48 hours of admission for General Internal Medicine (GIM) patients over the age of 65 at a large academic teaching hospital in Ontario. Secondary objectives included an assessment of the number of medication discrepancies and determination of the clinical importance. Eligible patients included those admitted to the GIM service at SJHH over the age of 65. Charts were reviewed for a medication reconciliation form and the time from admission to completion of the form was documented. The medication discrepancies were recorded, and two independent reviewers assessed their clinical importance using the National Coordinating Council for Medication Error Reporting and Prevention algorithm. 153 eligible patients admitted from January-April 2016 were included. 93 (61%) had medication reconciliation completed, with 36 (37%) completed within 48 hours of admission. The timing of medication reconciliation did not affect the number of medication discrepancies identified (IRR=1.18, p=0.49) or clinically important medication discrepancies identified (IRR=1.48, p=0.29). However, the number of medications per patient significantly affected both outcomes respectively (IRR=1.10 p<0.001, IRR=1.11 p=0.001). In conclusion, the current medication reconciliation program at SJHH is only reaching 61% of a priority group of GIM seniors, with only 37% reached within 48 hours of admission. Timing was not associated with the number of discrepancies found. To achieve 100% completion of medication reconciliation, a new process and additional resources would be required.