Evaluation of an inpatient computerized medication reconciliation system.

We designed the Pre-Admission Medication List (PAML) Builder medication reconciliation application and implemented it at two academic hospitals. We asked 1,714 users to complete a survey of their satisfaction with the application and analyzed factors associated with user efficiency. The survey was completed by 626 (36.5%) users. Most (64%) responders agreed that medication reconciliation improves patient care. Improvement requests included better medication information sources and propagation of medication information to order entry. Sixty-nine percent of admitting clinicians reported a typical time to build a PAML of <10 min. Decreased reported time to build a PAML was associated with reported experience with the application and ease of use but not the average number of medications on the PAML. Most users agreed that medication reconciliation improves patient care but requested tighter integration of the different stages of the medication reconciliation process. Further training may be helpful in improving user efficiency.

Design and implementation of an application and associated services to support interdisciplinary medication reconciliation efforts at an integrated healthcare delivery network.

Confusion about patients' medication regimens during the hospital admission and discharge process accounts for many preventable and serious medication errors. Many organizations have begun to redesign their clinical processes to address this patient safety concern. Partners HealthCare, an integrated delivery network in Boston, Massachusetts, has answered this interdisciplinary challenge by leveraging its multiple outpatient electronic medical records (EMR) and inpatient computerized provider order entry (CPOE) systems to facilitate the process of medication reconciliation. This manuscript describes the design of a novel application and the associated services that aggregate medication data from EMR and CPOE systems so that clinicians can efficiently generate an accurate pre-admission medication list. Information collected with the use of this application subsequently supports the writing of admission and discharge orders by physicians, performance of admission assessment by nurses, and reconciliation of inpatient orders by pharmacists. Results from early pilot testing suggest that this new medication reconciliation process is well accepted by clinicians and has significant potential to prevent medication errors during transitions of care.