P reventing harms from medication

errors or adverse drug events

remain a top patient safety priority all

over the world. It is believed that Medica-

tion Reconciliation (MR) is one of the

effective strategies to prevent them.

What is MR?

Medication reconciliation is a formal

process in which healthcare providers

work together with patients, families and

care providers to ensure accurate and

comprehensive medication information is

communicated consistently across transi-

tions of care. Medication reconciliation

requires a systematic and comprehensive

review of all the medications a patient is

actually taking to ensure that medications

being added, changed or discontinued

are carefully evaluated. It is a component

of medication management and will

inform and enable prescribers to make

the most appropriate prescribing deci-

sions for the patient.*

In fact, MR is not a new concept or initia-

tive that healthcare professionals should

adopt or implement. It is only a part of our

usual duties & responsibilities involved in

the daily operation of patent care in order

to provide the most accurate drug

treatment to the patient.

*http://www.ismp-canada.org/medrec/

Medication Reconciliation (MR)

Vol. 3

November 2011

Steps

commonly

involved in

Medication

Reconciliation

P. 2 P. 3

Highlights on the Interna-tional Medica-tion Safety (IMS) Confer-ence 2011

P. 4

Inside this issue:

Case sharing

Case 1: Wrong drugs prescribed & administered

during hospitalization

● A 73-year-old women with

past medical history of

diabetes, hypertension, chron-

ic renal failure and chronic

heart failure was admitted due

to shortness of breath & legs

edema.

● Five medications (Candesartan, Gliclazide,

Metformin, Metoprolol & Isosorbide Dinitrate)

were wrongly transcribed from an ePR print-out

which belonged to another patient admitted

earlier and so wrong drugs were prescribed to

her.

● After taking one dose of the above medica-

tions, patient’s condition deteriorated and a

Sentinel Event case was established.

Medication Safety Bulletin

Case 2: Wrong dosage prescribed & drug omitted

during discharge

● A 40-year-old patient had been taking

Risperidone during hospitalization but the drug

was omitted during discharge. Instead, she was

prescribed with Artane® 2mg tds and 6mg nocte

only.

● The incident was discovered after the patient

had missed Risperidone and taken the wrong

dosage of Artane® for 12 days.

● After checking with the last dispensing history

and patient discharge

summary in CMS,

Risperidone 6mg nocte

and Artane® 2mg om +

nocte were prescribed to

her again.

Page 2 Medication Safety Bulletin

Steps commonly involved in Medication Reconciliation

C urrently in HA, several IT features exist in the system to support and assist in medication

reconciliation process. Nevertheless, IT is only a tool. The staff culture and knowledge are of

utmost importance. The following are the six types of features which have been incorporated in our exist-

ing system. More new features to be implemented in the IPMOE will be discussed in the next issue which

will be published in May 2012.

Verification of patient

total drug profile:

Retrieval and revision of pa-

tient total drug profile include

● *Drugs prescribed by all

specialties under

Hospital Authority (HA)

● Drugs prescribed by

private institutions or

clinics

● Over-the-counter drugs

1

* Useful features in CMS

ePR Patient Summary

It summarizes all discharge / outpatient drugs with prescrip-tion and date within last 30 days

Limitations:

It only provides the prescribing record which is not necessarily the dispensing record. Thus, both ePR & CDDH should be checked to obtain the total HA drug profile Timeline display

It shows all medication and its corresponding dosage and frequency retrieved from Corporate Dispensed Drug History (CDDH). Default is set to be one year and clinician is able to change the period to longer than one year

Medication Identification

Function

Staff is able to retrieve drug image with drug color, mark-ing, shape, etc in case there is doubt about the identifica-tion of medication

Identification of drugs:

● Collection of drug packs

from patients including

those of total drug profile

● Checking any discrepancy

on drug pack with drug

record

● In case of doubt, staff can

contact pharmacy profes-

sionals for drug confirmation

or *using medication identifi-

cation function in CMS

2

* assistance from CMS; others: manual process

Clarification with patient/ caregiver:

● Clarify with patient/ caregiver what and how the patient is actually taking the drugs listed in

the total drug profile

● Check patient’s drug compliance and identify any side effects or drug related problems

(DRPs)

3

Page 3

Steps commonly involved in Medication Reconciliation

Discontinuation/ changes of drug record:

● In case certain drug is no longer suitable patient and his caregiver should be

instructed clearly

● The discontinuation / changes should be documented in physical and *CMS clinical

note

● Any changes should be marked in drug record for better subsequent management

and unintentional repetition of drugs (Future MOE / IPMOE)

Alert

Clinician can make use of alert function to alert other healthcare professionals any change of medication due to adverse events

Limitations:

Unlike drug allergy, the alert is not subject to system check

Reminder

Clinician is able to use reminder function to remind any change of medication. The screen will be prompt-ed out when clinician opens the profile of this patient unless the reminder has expired

Dispensed Record Summary This is a print-out summary of dispensed drugs to patient with detailed instructions & precau-tions in Chinese

Limitations:

It might not provide the complete drug profile

4

Communication/ handover

with different people:

● Medication reconciliation is

needed upon each

transition of care e.g. ward

transfer, discharge home,

discharge to OAH

● Clinician needs to

communicate with (i) other

healthcare providers upon

ward transfer; and (ii)

patient/ caregiver/ OAH

staff upon discharge

● Besides face to face com-

munication, clinician can

use *some CMS functions

to assist communication

5

* Useful features in CMS

Healthcare providers:

Patient/ caregiver/ OAH staff:

Page 4 Medication Safety Bulletin

This Bulletin is prepared by the Chief Pharmacist’s Office, HAHO

T he International Medication Safety Conference 2011, organized by the Hong Kong Hospital Authority

and supported by the Hong Kong Department of Health and the Centre for Food and Drug Safety of

the Chinese University of Hong Kong, had been held successfully on 2 & 3 November. About 500 local

healthcare practitioners and overseas delegates attended this meaningful event. The International Medi-

cation Safety Network (IMSN) first held its annual meeting in Asia, hence the theme “Medication Safety –

Dawn of a New Era” was chosen for this conference. The objective of the Conference was to promote

medication safety and strengthen the safety culture among the healthcare practitioners. More importantly,

it provided a valuable platform for networking the Asian countries in enhancing medication safety, and

hence delivering quality healthcare services.

The Conference comprised both plenary and concurrent lectures as well as booth and exhibit displays.

More than 20 overseas as well as local renowned speakers were invited to share their experience and

knowledge on medication safety. This year, apart from the thematic presentations, 24 posters focusing on

strategies to enhance medication safety were also displayed.

A number of guests from China and Hong Kong were invited to

officiate the Opening Ceremony of the Conference.

From left to right:

Prof Thomas Chan; Dr P Y Lam; Mr Anthony Wu; Mr Shao Ming-li;

Mr Richard Yuen; Dr P Y Leung; Dr Joseph Lui

Both Hong Kong Hospital Authority &

Department of Health shared some local med-

ication safety and quality initiatives & measures.

In addition, several countries/ cities from Asia Pacific were

invited to share their national reporting systems and works on

medication safety. They were well received by the audience. It

was hoped that other countries/ cities would find it useful and

applicable in their own healthcare systems.

Since both western and Chinese medicines

(CM) are commonly used together in Hong

Kong nowadays in the disease management, the safe use of

CM is undoubtedly important. Thus, a speaker was invited to

share his expertise in this area.

The presentations on that day were focused on 5 themes:

(1) incident reporting & prevention in overseas countries;

(2) staff engagement;

(3) medication safety in local old aged homes;

(4) community engagement & collaboration in Hong Kong; and

(5) strategies to enhance medication safety (oral presentations of the 6 selected abstract submissions)

Highlights on the International Medication Safety (IMS) Conference 2011