Defining and identifying concepts of medication reconciliation: An international pharmacy perspective.

BACKGROUND: Medication discrepancies occur in up to 80% of hospitalized patients during transitions of care, either at admission or discharge. However, numerous organization have different definitions of medication reconciliation which may result in variations of services being implemented.

OBJECTIVE: To develop a consensus definition of medication reconciliation and define the essential components of medication reconciliation based on international consensus using a modified Delphi process.

METHODS: Statements and definitions about medication reconciliation found in the literature were used to build a Delphi Questionnaire and sent to experts around the world. Experts were identified based on their leadership in publication, education, professional interest and participation in the area of medication management. Delphi rounds continued until an 80% agreement was achieved.

RESULTS: In total, 24 experts were included in the Delphi panel. Three Delphi rounds were required to reach consensus on the key concepts included in a medication reconciliation. These concepts included 65 statements classified under (1) tasks involved, (2) who can conduct them, (3) when they should be conducted, (4) who should receive them, (5) how should it be measured and (6) clarifying the difference between medication reconciliation and medication review. This led to a proposed definition for medication reconciliation tasks as "the process of creating the most accurate list possible of all medications a patient is taking and comparing that list against the prescriber's orders. In addition, the patient's allergies, history of side effects from medications and medication aids are listed with the goal of providing correct medication to the patient at all transition points within the health care system."

CONCLUSION: An international expert panel was able to receive consensus on the definition of tasks involved in medication reconciliation and its essential concepts after four Delphi rounds. This definition is broader in scope than previous definitions.