title: Medication reconciliation in hospice: a pilot study.
abstract: BACKGROUND
  The Joint Commission required implementation of medication reconciliation processes by January 2006. Medication reconciliation is the practice of acquiring an accurate medication history at each transitional point of care. Potential for errors increases with inaccurate medication histories. This study determined the extent of medication reconciliation errors in hospice.
  
  
  METHODS
  Patients were enrolled from 2 hospices in Maryland (January 2007). An initial medication history was completed by the nurse on hospice admission. The pharmacist did another medication history within 5 days of admission and compared the medication histories. All differences were reported as medication discrepancies.
  
  
  RESULTS
  There were 504 medication discrepancies. Medication omissions occurred most commonly. All patients had at least 1 medication discrepancy (average 8.7 per patient). Overall, 190 drug interactions were identified; most were moderately severe.
  
  
  CONCLUSIONS
  Terminal patients often use numerous medications increasing the risk of medication errors. Accurate medication histories reduce errors and potential for harm.
authors.affiliation: Methodist University Hospital, Memphis, Tennessee 38104, USA. kempl@methodisthealth.org
authors.forename: Leonette O
authors.initials: LO
authors.lastname: Kemp
authors.forename: Priyanka
authors.initials: P
authors.lastname: Narula
authors.forename: Mary Lynn
authors.initials: ML
authors.lastname: McPherson
authors.forename: Ilene
authors.initials: I
authors.lastname: Zuckerman
mesh_terms: D000369:Aged, 80 and over; D004347:Drug Interactions; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008396:Maryland; D008487:Medical History Taking; D008508:Medication Errors / Q000379:methods* / Q000706:statistics & numerical data*; D004366:Nonprescription Drugs; D010865:Pilot Projects; D055553:Prescription Drugs; D017064:Process Assessment, Health Care
chemical_list: D004366:Nonprescription Drugs; D055553:Prescription Drugs