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A systems approach to improving medication reconciliation in an academic medical center

Medication reconciliation decreases errors in patient medication lists by comparing patient medication orders with other medications a patient is currently taking. Discrepancies in medication lists can lead to adverse drug effects that are harmful to patients. Lack of standard procedures and best practices leads to miscommunication, procedural variability, and lack of accountability, especially given time and resource constraints. Nationwide, hospitals must comply with the regulations for medication reconciliation set forth in the American Recovery and Reinvestment Act of 2009. Observations in four ambulatory clinics at the University of Virginia Medical Center reveal patient-specific and clinic-specific factors contributing to variation in the medication reconciliation process. Current literature and studies of medication reconciliation offer a foundation for studying clinic workflows. Observations within the four ambulatory clinics focused on clinic-specific factors: engagement, procedural, and technological. The team observed the hospital staff interactions, clinic workflow, and electronic medical record use throughout the process. Comparisons reveal inconsistencies among clinic-specific factors, which affect the accuracy of medication reconciliation. These insights provide clinic managers with evidence to facilitate more accurate medication reconciliation and decrease medication errors.