This measure assesses the actual quality of the medication reconciliation process by identifying errors in admission and discharge medication orders due to problems with the medication reconciliation process. The target population is any hospitalized adult patient. The time frame is the hospitalization period.
At the time of admission, the admission orders are compared to the preadmission medication list (PAML) compiled by trained pharmacist (i.e., the gold standard) to look for discrepancies and identify which discrepancies were unintentional using brief medical record review. This process is repeated at the time of discharge where the discharge medication list is compared to the PAML and medications ordered during the hospitalization.
Measure Specs
General Information
Numerator
For each sampled inpatient in the denominator, the total number of unintentional medication discrepancies in admission orders plus the total number of unintentional medication discrepancies in discharge orders.
Denominator
The patient denominator is the sum of the number of medications in the gold standard medication lists plus the number of unintentionally ordered additional medications in a random sample of all adults admitted to the hospital. Our recommendation is that 25 patients are sampled per month, or approximately 1 patient per weekday.
So, for example, if among those 25 patients, there are 110 gold standard medications and 40 unintentionally ordered additional medications, and 75 unintentional discrepancies are identified, the measure outcome would be 75/150 = 0.5 discrepancies per medication per patient for that hospital for that month.
Exclusions
Patients that are discharged or expire before a gold standard medication list can be obtained.
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