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How to Improve Medication History and Reconciliation Processes in Ambulatory Care
Ambulatory Care

How to Improve Medication History and Reconciliation Processes in Ambulatory Care

Patients often have multiple providers involved in their care. According to a 2019 study published in the Annals of Internal Medicine, 30% of older Americans can see at least five different doctors in a year.  

On the one hand, patients are able to receive specialty care to help manage multiple, complex medical conditions. On the other hand, such fragmentation in care may lead to medication errors from inaccurate or incomplete patient medication lists. In response to this concern, ECRI addressed inaccurate medication lists in its Top 10 Patient Safety Concerns for 2023. 

As stewards of their patients' care, it is essential that primary care providers take steps to review and reconcile each patient's medication list to avoid errors or adverse drug events, and organizational leaders must ensure that systems are in place to support these efforts.  

Leaders should standardize the medication history and reconciliation processes for their organizations and devote resources to supporting those processes. With input from staff members, leaders can begin by developing a flowchart of the current medication history and reconciliation processes. The flowchart should capture who is responsible for obtaining medication histories, what information is gathered, where in the medical record the information is documented, and how the organization monitors and measures that medication histories are obtained and documented correctly. The flowchart should also capture the process for medication reconciliation including who is responsible for reconciling past medication history and the current medication list provided by the patient, when reconciliation occurs, where in the medical record the process is documented, and the process for monitoring and measuring that reconciliation is occurring correctly.  

Leaders should then assess whether any improvements need to be made, decide which resources are necessary to ensure processes are completed consistently and accurately, revise the flowchart to reflect any changes, and distribute the flowchart to all staff. 

Additional actions leaders can take include: 

  • Identify and address organizational factors that contribute to rushed or inaccurate medication history gathering and reconciliation (e.g., shortened appointment times, unclear or undesignated responsibility). 
  • Incorporate language in the patient appointment reminder (e.g., email, text, or phone call) asking patients to bring a list of all current medications, including over-the-counter (OTC) medications, supplements, herbal remedies, as well as information on dosage and frequency.  
  • Ensure a designated staff member reviews and updates the medication list in the patient's medical chart, including OTC medications, supplements, and herbal remedies, regardless of who prescribed them (e.g., the primary care organization should include birth control prescriptions that were prescribed by the patient's gynecologist in their primary care medical record). Encourage providers to reach out to referral or specialty providers if they have specific questions about a prescribed medication. 
  • Ensure a designated staff member also documents patient allergies or reactions to medications and verifies the list at every visit.  
  • Confirm with the information technology department that the electronic health record is set up to prompt a designated staff member to document that the medication history and reconciliation processes have occurred. The record should also clearly display patient allergies and prompt the provider if the patient is allergic to a prescribed medication. 

Providers and staff members should engage patients in the medication history and reconciliation processes. Primary care providers and staff should engage and encourage patients to participate in their care during the medication history and reconciliation processes.  

  • Assess each patient's level of health literacy. Ask questions to determine the patient's level of understanding and adherence to their medication regimen, including any challenges the patient may have that may lead to noncompliance. 
  • Reinforce with patients the importance of maintaining a current medication list and bringing it to every healthcare encounter, including when seeing other healthcare providers ( e.g., dentists, behavioral health professionals). 
  • Provide information to patients regarding any new prescriptions (e.g., food or other drug interactions). 
  • Provide a visit summary to patients during each visit and include a list of all of their medications, dosages, and frequencies. Encourage patients to keep this information and share it with their other healthcare providers. 

Want to learn more about this issue and other top concerns? View ECRI's Top 10 Patient Safety Concerns for 2023 or reach out to an ECRI expert for further assistance.