High 5s initiative: implementation of medication reconciliation in France a 5 years experimentation

Abstract

The International High 5s Project was developed by the World Health Organisation to address major concernsabout patient safety. The Standard Operating Protocol (SOP) for ensuring medication accuracy during transitionalcare is a part of the High 5s Project. The impetus behind medication reconciliation is to prevent adverse drugevents by decreasing the rate of undocumented discrepancies as patients move from one level of care to another.The aim of this article is to present the results of the French experimentation.During 5 years, 9 healthcare facilities implemented the SOP Medication Reconciliation at admission. Eligible inpatientsincluded patients aged over 65 years admitted through the Emergency Department. The indicator for the rate ofundocumented discrepancies is assessed as the time required per reconciliation.From 2010 to 2014, 27 447 inpatients were reconciled (14.0% of eligible patients for reconciliation). The mean ofundocumented discrepancies per patient was 1.7 (46 188). Among the undocumented discrepancies, unintentionalmedication errors which are at the same time non documented and non intentional stand out (however one healthfacility used a different methodology): the mean of intercepted and corrected medication errors was 0.9 (21 320 for 22863 patients). All were resolved during the collaborative exchange between pharmacists and physicians. The meantime to perform the reconciliation was about 31.8 min (IC 95% [31.6; 32.0]).In France the medication reconciliation process has demonstrated to be a powerful strategy to reduce undocumenteddiscrepancies and in particular medication errors. The next steps should focus on extending the process either to allstages of the transitional care or to different types of patients (other than Emergency room patients) or health sectors.