Medication reconciliation in hemodialysis patients.

Medication reconciliation is an effective process to reduce adverse drug events (ADEs) and harm associated with the loss of medication information as patients transfer between health care settings. Patients with end stage renal disease (ESRD) are at a high risk of experiencing drug-related problems (DRPs) because they take many medications, have multiple comorbidities, and require frequent medication changes. We evaluated the potential impact of medication reconciliation and optimization in the ambulatory care setting at the time of patient transfer from an in-centre dialysis unit to a satellite dialysis unit. Overall, 15 patients (78.8%) had at least one unintended medication variance. The majority of unintended variances (56%) were caused by the physician/nurse practitioner (NP) omitting an order for medication that the patient was taking. In this small study, medication reconciliation was effective at identifying and rectifying medication errors and optimizing pharmacotherapy at the time of transfer from an in-centre hemodialysis to a satellite dialysis unit.