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

The International High 5s Project was developed by the World Health Organisation to address major concerns about patient safety. The Standard Operating Protocol (SOP) for ensuring medication accuracy during transitional care is a part of the High 5s Project. The impetus behind medication reconciliation is to prevent adverse drug events 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 inpatients included patients aged over 65 years admitted through the Emergency Department. The indicator for the rate of undocumented 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 of undocumented discrepancies per patient was 1.7 (46 188). Among the undocumented discrepancies, unintentional medication errors which are at the same time non documented and non intentional stand out (however one health facility used a different methodology): the mean of intercepted and corrected medication errors was 0.9 (21 320 for 22 863 patients). All were resolved during the collaborative exchange between pharmacists and physicians. The mean time 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 undocumented discrepancies and in particular medication errors. The next steps should focus on extending the process either to all stages of the transitional care or to different types of patients (other than Emergency room patients) or health sectors.