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.


CONCLUSIONS
Pharmacists' medication reconciliation-related clinical interventions indicate that the time and effort of performing medication reconciliation activities results in benefits for patients.
Gardner
Brian
B
Mayo Eugenio Litta Children's Hospital, Rochester, Minnesota, USA. Gardner.Brian@mayo.edu
Graner
Kevin
K
D004344:Drug Incompatibility; D017598:Efficiency, Organizational; D006776:Hospitals, Pediatric; D006801:Humans; D020407:Internet; D016347:Medical Records Systems, Computerized / Q000458:organization & administration; D008508:Medication Errors / Q000517:prevention & control*; D008910:Minnesota; D019982:Organizational Case Studies; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D016730:Program Development; D014584:User-Computer Interface