Medication reconciliation service in Tan Tock Seng Hospital.

PURPOSE: Medication reconciliation is integral to every hospital. Approximately 60 percent of all hospital medication errors occur at admission, intra-hospital transfer or discharge. Effectively and consistently performing medication reconciliation at care-interfaces continues to be a challenge. Tan Tock Seng Hospital (TTSH) averages 4,700 admissions monthly. Many patients are elderly (> 65 years old) at risk from poly-pharmacy. As part of a medication safety initiative, pharmacy staff started a medication reconciliation service in 2007, which expanded to include all patients in October 2009. This article aims to describe the TTSH medication reconciliation system and to highlight common medication errors occurring following incomplete medication reconciliation.

DESIGN/METHODOLOGY/APPROACH: Where possible, patients admitted into TTSH are seen by pharmacy staff within 24 hours of admission. A form was created to document their medications, which is filed into the case sheets for referencing purposes. Any discrepancies in medicines are brought to doctors' attention. Patients are also counseled about changes to their medications. Errors picked up were captured in an Excel database.

FINDINGS: The most common medication error was prescribers missing out medications. The second commonest was recording different doses and regimens. The reason was mainly due to doctors transcribing medications inaccurately.

RESEARCH LIMITATIONS/IMPLICATIONS: This is a descriptive study and no statistical tests were carried out. Data entry was done by different pharmacy staff, and not a dedicated person; hence, data might be under-reported.

PRACTICAL IMPLICATIONS: The findings demonstrate the importance of medication reconciliation on admission. Accurate medication reconciliation can help to reduce transcription errors and improve service quality.

ORIGINALITY/VALUE: The article highlights medication reconciliation's importance and has implications for healthcare professionals in all countries.