Clinical Outcomes of a Home-Based Medication Reconciliation Program After Discharge from a Skilled Nursing Facility

From Pharmacotherapy The transfer of patients from one health care setting to another can be associated with poor postdischarge outcomes. Recent evaluations suggest that approximately 20% of patients discharged to home from a hospital will experience an adverse event (i.e., an injury caused by medical management) during this transition and that 66-72% of these events are drug related. Assuming a frail patient population with multiple comorbidities, one might argue that patients discharged from a skilled nursing facility (SNF) are at greater risk of experiencing an adverse event. With appropriate transitional care, however, such poor outcomes may be prevented and/or mitigated. An important component of transitional care is the review and reconciliation of drug orders between two transition points. The term medication reconciliation refers to the process of comparing the drugs that the patient, client, or resident has been taking before the time of admission or entry to a new setting with the drugs that the organization is about to provide. A "new setting" could include an SNF, hospital, or ambulatory care and other settings. An analysis of changes in drug therapy for primary care patients discharged from an acute care facility revealed a 50% turnover in drugs used between the primary care practice and acute care facility. For example, antihypertensive drugs were discontinued whereas antiulcer agents were begun widely in acute care facilities, resulting in confusion among discharged patients as to which drugs they should be continuing after discharge. Medication reconciliation, thus, is a critical component of a patient's transition between levels of care. Accrediting organizations, such as the Joint Commission, have included medication reconciliation as part of their goals to help promote patient safety.