Implementation of medication reconciliation at admission and discharge in Ministry of Defense Health Services hospitals: a multicentre study

There is potential for many medication errors to occur due to the complex medication use process. The medication reconciliation process can significantly lower the incidence of medication errors that may arise from an incomplete or inaccurate medication history as well as reductions in length of hospital stay, patients’ readmissions and lower healthcare costs. The quality improvement collaborative project was conducted as a pilot study in two hospitals, then implemented on a broader scale in 18 hospitals in Saudi Arabia. The goal of the project was to reduce the percentage of patients with at least one outstanding unintentional discrepancy at admission by 50%, over 16-month period (July 2020–November 2021). Our interventions were based on the High 5’s project medication reconciliation WHO, and Medications at Transitions and Clinical Handoffs toolkit for medication reconciliation by Agency for Healthcare Research and Quality. Improvement teams used the Institute of Healthcare Improvement’s (IHI’s) Model for improvement as a tool for testing and implementing changes. Collaboration and learning between hospitals were facilitated by conducting learning sessions using the IHI’s Collaborative Model for Achieving Breakthrough Improvement. The improvement teams underwent three cycles. By the end of the project significant improvements were observed. The percentage of patients with at least one outstanding unintentional discrepancy at admission showed a 20% reduction (27% before, 7% after; p value <0.05) (Relative Risk (RR) 0.74) with a mean reduction in the number of discrepancies per patient by 0.74. The percentage of patients with at least one outstanding unintentional discrepancy at discharge showed 12% reduction (17% before, 5% after; p value <0.05) (RR 0.71) with a mean reduction in the number of discrepancies per patient by 0.34. Compliance to medication reconciliation documentation within 24 hours of admission and discharge showed significant improvement by an average of 17% and 24%, respectively. Additionally, the implementation of medication reconciliation had a negative correlation with the percentage of patients with at least one outstanding unintentional discrepancy at admission and discharge.