Effect of medication reconciliation with and without patient counseling on the number of pharmaceutical interventions among patients discharged from the hospital.
The process of medication reconciliation—reviewing a patient's medication regimen to eliminate unintended discrepancies and check for drug–drug interactions—is an important aspect of preventing adverse events after hospital discharge. Various approaches to medication reconciliation have been studied, including using pharmacists to reconcile medications and integrating medication reconciliation with electronic medical records, but as yet the most effective method is not clear. This study, conducted at an academic medical center in the Netherlands, directly involved patients in the reconciliation process by specifically asking patients about their actual medication use and medication side effects, and educating patients about their medications. Involving patients resulted in significantly more medication adjustments and likely more accurate medication reconciliation. This study highlights the importance of involving patients in safety efforts, which is a 2009 Joint Commission National Patient Safety Goal.