NQF endorses hospital medication reconciliation measure

Is a lax medication reconciliation process producing errors at your hospital? The National Quality Forum has endorsed a new quality measure aimed at identifying medication discrepancies and the process gaps that caused them. Measure #2456, officially endorsed by the NQF in September, assesses the quality of a hospital’s medication reconciliation process by identifying errors in admission and discharge orders. Here’s how it works: At the time of admission, hospital medication orders are compared with the preadmission medication list, which is compiled by a pharmacist. At discharge, the pharmacist repeats the process using both the preadmission list and any medications ordered during the hospitalization.

[RW] NQF-endorsed process measures aimed at improving medication reconciliation

This type of review can help identify both history errors and reconciliation errors. History errors occur when a mistake in the history leads to an error in the medication order. For instance, if the clinical team in the hospital didn’t know a patient was on aspirin when they were admitted, they wouldn’t order it at admission.

If the history is correct, but the medication orders don’t match the preadmission medication list, that could be an intentional change by the care team or a reconciliation error.

The pharmacist can usually determine which one it is by reviewing the chart or consulting the care team, said Dr. Jeffrey L. Schnipper, a hospitalist at Brigham and Women’s Hospital in Boston, who proposed the new NQF measure.

The new measure joins five NQF-endorsed process measures aimed at improving medication reconciliation. But the new measure is the first outcome measure.

The Joint Commission also requires hospitals to engage in medication reconciliation, but that mandate is mostly pro forma, Dr. Schnipper said.