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Medication Reviews and Medication Reconciliation

Updated: May 15

Our research team had the chance to read through and discuss the article titled: Drug-related problems and medication reviews among old people with dementia published in BMC Pharmacology and Toxicology in 2017 by authors Bettina Pfister, Jeanette Jonsson, and Maria Gustafsson [1]. This article investigated the outcomes of drug related problems (DRPs) including hospitalizations and readmissions. This study used data from a past randomized control trial, conducted between 2012 and 2014 in the orthopedic and medicine wards in two hospitals. They investigated the effects of pharmacists’ intervention as part of a hospital ward team in patients with dementia or cognitive impairment. The participants were randomized into two groups, the control or intervention group, in which the additional services provided to the intervention group included clinical pharmacists conducting medication reviews, medication reconciliation, and clinical pharmacists participating in ward rounds in hospital settings to address DRPs. This study highlighted the aspects that are necessary in a medication review. The reason we chose to discuss this article was because it focused on medication reviews with cognitive impairment and dementia, which is a focus of our research.


Similar to the study discussed in the article, our research team constructed and validated our own standardized medication review checklist, titled MedRevCiD, a Medication Review in Cognitive impairment and Dementia. We wanted to see how our checklist was similar and different from the medication review they used in the study. We found that we had similar components, however we captured in differently. Ours was captured through different domains while theirs were more explicit. For example, one of their key components was adding a medication reconciliation. In ours, this section was less explicit. As we read through the journal, we compared if our MedRevCiD checklist had the specific medication related components that were mentioned. This included drug-drug interactions, contraindications, swallowing problems, potential inappropriate drugs such as benzodiazepines, and so on. We were happy to note that our comprehensive MedRevCiD included all those components except one, and this was an explicit recommendation for performing a medication reconciliation.


According to the Institute for Healthcare Improvement, medication reconciliation is the process of ensuring that medication administration records are updated, accurate, and complete [2]. Various information sources should be used to complete this, including drug lists from primary care centers, the patients’ hospital medical records, and when possible, interviews with patients and/or relatives. By obtaining a patient’s comprehensive medication list, we can assess potential drug-drug interactions including prescription drugs, non-prescription drugs, vitamins, natural and herbal supplements, that the pharmacist would otherwise be unaware of. The article highlighted that both medication reviews alongside medication reconciliation are necessary to ultimately reduce patient’s DRPs. We made sure to add a note of this throughout our checklist to ensure that the pharmacist performing the medication review also has this in the back of their mind.


Table 1: Important aspects to consider when performing a medication review [1]

Impaired body function

​renal function, liver function, contraindications, allergies, swallowing problems

Certain drugs that need special attention

toxic drugs, drugs prone to producing side effects, potentially inappropriate drugs

Interactions

drug-drug, drug-food interactions, interactions between drugs and herbal medicinal products

The patient’s clinical symptoms in relation to drug treatment

symptoms (adverse drug reactions)

Overall view of the patients’ medication

proper drug selection, dosage, duration of treatment, polypharmacy, indication for therapy, untreated indication, compliance, OTC drugs, effectiveness, cost-effectiveness and general judgment of the patient’s drug use

Medication reconciliation

​by conducting medication reconciliation, the pharmacists ensure that the medication administration records used at the wards are updated, accurate, and complete. Various information sources should be used, including drug lists from primary care centers, the patients’ hospital medical records, and when possible, interviews with patients and/or relatives.

  1. Pfister, B, Jonsson, J, Gustafsson, M. (2017). Drug-related problems and medication reviews among old people with dementia. BMC Pharmacol Toxicol. 2017; 18: 52. Link to article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488493/

  2. Medication Reconciliation to Prevent Adverse Drug Events: IHI. (n.d.). Retrieved from http://www.ihi.org/Topics/ADEsMedicationReconciliation/Pages/default.aspx


Reflection question: Why is doing a medication reconciliation important? Tell us your thoughts and let us know how they were important to you!


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