RESUMEN
BACKGROUND: Gathering a complete preadmission medication list (PAML) at admission remains an essential component of medication reconciliation, as is providing the patient with a written medication list at the time of hospital discharge. A medication reconciliation project was begun in 2007 at an integrated health care system to (1) improve the accuracy of PAMLs within 24 hours of admission for patients admitted through the emergency department (ED) and (2) enhance patient education through telephone calls by pharmacists to the patients most at risk for adverse drug events (ADEs) or readmission. ACCURACY OF PAMLs: In the October 2007-May 2008 period, RN-generated PAMLs were accurate 16% of the time versus 89% for the June 2008-December 2010 period, when they were generated by pharmacy technicians. Medication errors classified as having the potential to cause moderate or serious harm decreased from 13.17% to 1.50%. POSTDISCHARGE EDUCATION OF COMPLEX PATIENTS BY PHARMACISTS: By summer 2009, the Safe Med pharmacist program was fully staffed, thereby enabling the program to contact nearly 100% of the 10,174 patients meeting the Safe Med criteria from January 2009 through December 2010. When compared with historical controls, the Safe Med intervention was associated with a statistically significant reduction in 30- and 60-day readmissions, ADE-associated 30- and 60-day readmissions, and 30- and 60-day ED visits. CONCLUSIONS: ED-deployed pharmacy personnel can enhance the accuracy of PAMLs and may thereby reduce in-hospital ADEs. The postdischarge intervention by pharmacists with the most complex patients may reduce ADEs following hospital discharge. The interventions may compensate for discontinuities in care and lessen the attendant threats to patient safety.