Medication reconciliation in ambulatory care: Attempts at improvement

Objective: To enhance overall accuracy of medication lists by providing performance feedback and training to the healthcare team and increasing patient participation in the medication reconciliation process. Methods: This prospective study involved patients seen in four academic, ambulatory primary care internal medicine clinics. Before the interventions, baseline data were analysed, assessing completeness, correctness and accuracy of medication documentation in the electronic medical record. Interventions to provide performance feedback and training to the healthcare team, increase patient awareness and participation in the medication reconciliation process were implemented. Immediately after each intervention, a data collection was undertaken to assess the effectiveness of the intervention on the accuracy of individual medications and medication lists. Results: Completeness of medication lists improved from 20.4% to 50.4% (p<0.001). The incomplete documentation of medication lists was mostly because of lack of frequency (15.4%) and route (8.9%) for individual medications within a medication list. Correctness of medication lists improved from 23.1% to 37.7% (p = 0.087). The incorrectness in a medication list was mostly because of incorrect medications dose. Patient participation in the medication reconciliation process increased from 13.9% to 33% (p<0.001). The medication list accuracy improved from 11.5% to 29% (p = 0.014). Conclusion: In this setting, it was helpful to engage the active participation of all members of the healthcare team and most importantly the patient to improve the accuracy of medication lists.