Murphy EM, Oxencis CJ, Klauck JA, Meyer DA, Zimmerman JM. Medication reconciliation at an academic medical center: Implementation of a comprehensive program from admission to discharge. American Journal of Health-System Pharmacy. 2009 Dec 1;66(23):2126-2131.

A multidisciplinary team developed a new process for the pharmacist to obtain an extensive medication history on hospital admission, and then reconcile medication histories using a discharge medication reconciliation report generated by a electronic medical record medication documentation tool. Pharmacists received intensive training and hospitalwide multidisciplinary education was provided. The authors conclude that a pharmacy-driven multidisciplinary admission history and medication reconciliation process reduced medication errors from 90 percent to 47 percent on the surgical unit, and from 57 percent to 33 percent on the medicine unit.

Singh R, McLean-Plunckett EA, Kee R, et al. Experience with a trigger tool for identifying adverse drug events among older adults in ambulatory primary care. Quality and Safety in Health Care. 2009 Jun;18(3):199-204.

This study evaluated the performance of a 39-item trigger tool for identifying adverse drug events (ADEs) among older adults in ambulatory primary care practices. The authors conclude that trigger tools have a potential role in driving quality improvement in ambulatory primary care. Nine triggers accounted for 94.4 percent of ADEs detected, suggesting the possibility of a much briefer tool. Practical issues related to adoption of such tools by practicing physicians should be further explored.

Wortman SB. Medication reconciliation in a community, nonteaching hospital. American Journal of Health System Pharmacy. 2008 Nov 1;65(21):2047-2054.

This article describes the development and implementation of a medication reconciliation program at a 250-bed community hospital. The program involved the adoption of facility-wide policies and procedures, including the use of standardized medication reconciliation forms, staff education, and monthly audits to gauge progress. Strengths, weaknesses, and prospects for future expansion of the program are discussed.

Miller SL, Miller S, Balon J, Helling TS. Medication reconciliation in a rural trauma population. Annals of Emergency Medicine. 2008 Nov;52(5):483-491.

This study assessed the accuracy of medication histories documented on admission for patients admitted to a rural Level 1 trauma center. Results showed that almost all of the initial medication histories were inaccurate as compared against the pharmacist-obtained lists and that multiple factors contributed to medication history errors. The authors discuss these results and comment on aspects of the trauma setting that may pose particular challenges to accurate medication reconciliation.

Sharek PJ, McClead RE Jr, Taketomo C, et al. An intervention to decrease narcotic-related adverse drug events in children's hospitals. Pediatrics. 2008 Oct;122(4):e861-866.

The most common adverse drug events (ADEs) in hospitalized children are related to narcotics. Large-scale collaborative quality improvement efforts to decrease narcotic-related ADEs in pediatrics have not been widely published. This article reports on fourteen children’s hospitals in an improvement collaborative that implemented a collection of expert panel-defined best practices and reduced pediatric narcotic-related adverse drug events by 67 percent.

Weber LM, Ghafoor VL, Phelps P. Implementation of standard order sets for patient-controlled analgesia. American Journal of Health-System Pharmacy. 2008 Jun 15;65(12):1184-1191.

This case study describes the development and implementation of standard order sets to improve the safety of opioid-based patient-controlled analgesia (PCA). Post-intervention assessment showed that the implementation of standard order sets sharply reduced the incidence of PCA-associated respiratory depression. Changing the order sets to improve medication safety did not appear to negatively affect patient satisfaction with pain management.

Kaushal R, Bates DW, Abramson EL, Soukup JR, Goldmann DA. Unit-based clinical pharmacists’ prevention of serious medication errors in pediatric inpatients. American Journal of Health-System Pharmacy. 2008 Jul 1;(65)13:1254-1260.

This study measured rates of serious medication errors in three pediatric inpatient units (intensive care, general medical, and general surgical) before and after introduction of unit-based clinical pharmacists. The authors conclude that a full-time unit-based clinical pharmacist substantially decreased the rate of serious medication errors in a pediatric ICU, but a part-time pharmacist was not as effective in decreasing errors in pediatric general care units.

Cohen H. Protecting patients from harm: Reduce the risks of high-alert drugs. Nursing2007. 2007 Sept;37(9):49-55.

Learn how adapting processes for prescribing, preparing, and administering can help reduce errors associated with certain high-alert medications. This article is part of a series that describes the IHI's 5 Million Lives Campaign recommended interventions from a front-line nursing perspective.

Federico F. Preventing harm from high-alert medication. Joint Commission Journal on Quality and Patient Safety. 2007 Sept;33(9):537-542.

The author describes the Institute for Healthcare Improvement 5 Million Lives Campaign intervention to prevent patient harm from high-alert medications, starting with a focus on anticoagulants, sedatives, narcotics, and insulin. This article is the second in a series on the 5 Million Lives Campaign.

Meisel M, Meisel S. Best-practice protocols: Reducing harm from high-alert medications. Nursing Management. 2007 July;38(7):31-39.

This second article in a series describes reducing harm to patients from high-alert medications by reviewing a case study on the importance of postoperative monitoring of opioid-naive patients who are receiving narcotics. The series presents a nursing management perspective on the six interventions recommended by the Institute for Healthcare Improvement as part of its 5 Million Lives Campaign to protect patients from five million incidents of medical harm over a two-year period.

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