title: Evaluation of medication reconciliation in an ambulatory setting before and after pharmacist intervention.
abstract: OBJECTIVE
  To determine the accuracy of medication reconciliation in an internal medicine clinic and to evaluate pharmacist interventions targeted at improving the accuracy of medication reconciliation.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Memphis, TN, from October 2007 to March 2008.
  
  
  METHODS
  180 adults attending an internal medicine appointment.
  
  
  METHODS
  On patient arrival, a nurse completed the medication reconciliation form. In Phase 1 of the study, a pharmacist randomly selected and reviewed a patient's medication reconciliation form, interviewed the patient, and verified information if indicated. A total of 90 forms were reviewed and compared to determine baseline medication reconciliation accuracy. Education interventions were held with the medical and nursing staff, targeting areas for improvement. In Phase 2 of the study, 90 additional medication reconciliation forms were reviewed in the same manner. Phase 1 and Phase 2 results were compared to evaluate differences in accuracy after the pharmacist's education interventions.
  
  
  METHODS
  Accuracy of medication reconciliation forms and number of potentially significant errors at baseline and after pharmacist interventions.
  
  
  RESULTS
  In Phase 1, 14.4% of medication reconciliation forms were correct. The remaining forms contained 190 potentially significant errors. After the education interventions, 18.9% of medication reconciliation forms were correct and the others contained 139 potentially significant errors.
  
  
  CONCLUSIONS
  Medication reconciliation accuracy is poor. Although education interventions showed a trend toward improvement, continued education training for staff and patients is needed in addition to other interventions to optimize this process and prevent medication errors.
authors.affiliation: Regional Medical Center, Memphis, TN, USA. lpeyton@uu.edu
authors.forename: Lauren
authors.initials: L
authors.lastname: Peyton
authors.forename: Kristie
authors.initials: K
authors.lastname: Ramser
authors.forename: Gale
authors.initials: G
authors.lastname: Hamann
authors.forename: Dipika
authors.initials: D
authors.lastname: Patel
authors.forename: David
authors.initials: D
authors.lastname: Kuhl
authors.forename: Laura
authors.initials: L
authors.lastname: Sprabery
authors.forename: Bruce
authors.initials: B
authors.lastname: Steinhauer
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007318:Inservice Training; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D008875:Middle Aged; D009726:Nurses; D010044:Outpatient Clinics, Hospital; D010353:Patient Education as Topic / Q000379:methods; D010595:Pharmacists; D015397:Program Evaluation; D011996:Records; D016903:Drug Monitoring