Improving the Efficiency of Medication Reconciliation in Two Taiwanese Hospitals by Using the Taiwan National Health Insurance PharmaCloud Medication System

Pei-Pei Huang,1,&ast; Samantha Yun-Kai Poon,2,&ast; Shao-Hsuan Chang,3 Chien-Wen Kuo,4 Ming-Wen Chien,1 Chien-Chih Chen,5 Shao-Chin Chiang2,6 1Division of Outpatient Pharmacy, Department of Pharmacy, Cheng Hsin General Hospital, Taipei, Taiwan; 2Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University (Yang Ming Campus), Taipei, Taiwan; 3Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA; 4Department of Pharmacy, Cheng Hsin General Hospital, Taipei, Taiwan; 5Division of Colorectal Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; 6Department of Pharmacy, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan&ast;These authors contributed equally to this workCorrespondence: Shao-Chin Chiang, Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University (Yang Ming Campus), Taipei, Taiwan, Tel +886-983641216, Email scchiang316@nycu.edu.tw; scchiang@kfsyscc.orgPurpose: Medication reconciliation (MedRec) is a process to ensure complete and accurate communication of patient medication information throughout care transitions to prevent medication errors. Hospitals in Taiwan have stride to implement a universal protocol for MedRec. To establish a feasible protocol indigenously, the World Health Organization (WHO) protocol was incorporated with the Taiwan National Health Insurance (NHI) PharmaCloud patient medication profile. The efficiency and error detection capability of this modified protocol was evaluated in two hospitals.Methods: A prospective, non-randomized, unblinded, multicenter cohort study was conducted. Subjects were recruited among patients admitted for colorectal or orthopedic surgery with at least 4 or more chronic drugs. To obtain the best possible medication history (BPMH), the control group was conducted according to the WHO protocol, and the experimental group used the modified WHO protocol with the medication data from the PharmaCloud system. The time spent on the two protocols was recorded. Admission and discharge orders were reconciled against the BPMH to identify any discrepancies. Discrepancies were evaluated by appropriateness, prescribing intentions, and types of inappropriateness. The levels of potential harm were classified for inappropriate discrepancies.Results: The mean time to obtain BPMH in the control group was 34.3± 10.8 minutes and in the experimental group 27.5± 11.5 minutes (P = 0.01). The experimental group had more subjects with discrepancies (87.9%) than the control (58.3%) (p < 0.001). The discrepancies in both admission and discharge orders for the experimental group (84.5 and 67.2%) were higher than those of the control (47.9 and 37.5%). Many inappropriate discrepancies were classified as the potential harm of level 2 (77.8%).Conclusion: Through the establishment of BPMH with the medication data from the Taiwan NHI PharmaCloud, MedRec could be achieved with greater efficiency and error detection capability in both the admission and discharge order validation processes.Keywords: medication reconciliation, prescription discrepancy, PharmaCloud, best possible medication history, BPMH