Perioperative Medication Management (POMM) Pilot: Integrating a Community-Based Medication History (MedsCheck) into Medication Reconciliation for Elective Orthopedic Surgery Inpatients

Background: Medication safety along the continuum of care is dependent on the quality of medication information at each point of transfer. The purpose of our study was to assess the impact of integrating a community-based medication history (MedsCheck) into perioperative medication reconciliation for elective orthopedic surgery patients by assessing postoperative unintentional medication discrepancies. Secondary objectives were to evaluate community pharmacist participation and patient satisfaction. Methods: Patients scheduled for elective hip or knee surgery between April and September 2008 were identified as the study population. Patients and community pharmacies were contacted to coordinate the MedsCheck prior to the pre-admission clinic visit. At the visit, the Meds Check document was used to prepare a best possible medication history, which was documented in the patient chart. Medications were reconciled postoperatively. Participants were surveyed for feedback on the process. Results: Eighty-two patients were included in the study. A MedsCheck was completed for 73.8% (31/42) of eligible patients who were contacted prior to their pre-admission clinic visit. The average number of medications per patient was 8.4. The percentage of patients with at least 1 unintentional medication discrepancy decreased from 68.4% (13/19) to 47.6% (39/82) post-intervention. Total unintentional medication discrepancies decreased from 25.6% to 10.6%. Discussion: Integrating MedsCheck into the perioperative medication reconciliation process resulted in positive outcomes. The main challenge was coordination of the MedsCheck service prior to the patient's pre-admission clinic visit. Conclusion: Integrating MedsCheck into routine perioperative care for orthopedic patients is a feasible way to facilitate pharmacist medication reconciliation and increase patient satisfaction.