Medication reconciliation in ambulatory oncology.

BACKGROUND: Few models for medication reconciliation in ambulatory primary or specialty care have been described, perhaps because of the special challenges posed by this environment.
METHODS: Dana-Farber Cancer Institute (Boston) created a reconciliation program that was designed as a patient-clinician partnership intervention. Policies that require clinicians to review and update medication lists at regular appointments were augmented. Clinic assistants printed patients' medication lists from the electronic medical record and distributed lists to established patients for review. Patients provided updated lists to their oncology clinicians. Clinicians then entered the information or indicated changes to be entered by a pharmacist.
RESULTS: At baseline, 81% of patients' medication lists included at least one error or omission. With medication reconciliation, 90% of incorrect medication lists were updated. In contrast, only 2% of medication lists were corrected among patients who received "usual" care (p < .001). DISCUSSION: From the program's inception in November 2005 through August 2007, patients and staff reconciled 24,148 medication lists by making 53,040 changes to 168,475 listed drugs, a rate of 31 changes per 100 medications. Implementation required broad staff engagement and ongoing attention to operational issues.