title: Nurse-pharmacist collaboration on medication reconciliation prevents potential harm.
abstract: BACKGROUND
  Medication reconciliation can prevent some adverse drug events (ADEs). Our prospective study explored whether an easily replicable nurse-pharmacist led medication reconciliation process could efficiently and inexpensively prevent potential ADEs.
  
  
  METHODS
  Nurses at a 1000 bed urban, tertiary care hospital developed the home medication list (HML) through patient interview. If a patient was not able to provide a written HML or recall medications, the nurses reviewed the electronic record along with other sources. The nurses then compared the HML to the patient's active inpatient medications and judged whether the discrepancies were intentional or potentially unintentional. This was repeated at discharge as well. If the prescriber changed the order when contacted about a potential unintentional discrepancy, it was categorized as unintentional and rated on a 1-3 potential harm scale.
  
  
  RESULTS
  The study included 563 patients. HML information gathering averaged 29 minutes. Two hundred twenty-five patients (40%; 95% confidence interval [CI], 36%-44%) had at least 1 unintended discrepancy on admission or discharge. One hundred sixty-two of the 225 patients had an unintended discrepancy ranked 2 or 3 on the harm scale. It cost $113.64 to find 1 potentially harmful discrepancy. Based on the 2008 cost of an ADE, preventing 1 discrepancy in every 290 patient encounters would offset the intervention costs. We potentially averted 81 ADEs for every 290 patients.
  
  
  CONCLUSIONS
  Potentially harmful medication discrepancies occurred frequently at both admission and discharge. A nurse-pharmacist collaboration allowed many discrepancies to be reconciled before causing harm. The collaboration was efficient and cost-effective, and the process potentially improves patient safety.
authors.affiliation: School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA. LF@jhmi.edu
authors.forename: Leonard S
authors.initials: LS
authors.lastname: Feldman
authors.forename: Linda L
authors.initials: LL
authors.lastname: Costa
authors.forename: E Robert
authors.initials: ER
authors.lastname: Feroli
authors.forename: Terry
authors.initials: T
authors.lastname: Nelson
authors.forename: Stephanie S
authors.initials: SS
authors.lastname: Poe
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.forename: Leigh E
authors.initials: LE
authors.lastname: Efird
authors.forename: Redonda G
authors.initials: RG
authors.lastname: Miller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D008297:Male; D059065:Medication Reconciliation / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D009726:Nurses / Q000592:standards; D010348:Patient Care Team / Q000592:standards; D061214:Patient Safety / Q000592:standards*; D004364:Pharmaceutical Preparations / Q000008:administration & dosage / Q000592:standards; D010595:Pharmacists / Q000592:standards
chemical_list: D004364:Pharmaceutical Preparations