The Development of Electronic Medical Reconciliation System in Lampang Hospital

Abstract

Background: The highest medication errors in the inpatient wards of Lampang Hospital in 2022 were patients not receiving the medication they should have (28.3%) and prescribing the wrong medication (24.9%). These errors can be prevented with a medication reconciliation system.

Objective: To develop and evaluate an electronic system for medication continuity and consistency using the E-Medical Reconciliation program.

Methods: This mixed-method research was conducted from July 1, 2023, to March 31, 2024. Qualitative data were collected to analyze existing system issues and survey expectations for developing the E-Medical Reconciliation system for use in five internal medicine wards. Quantitative data on the percentage of medication reconciliations performed within 24 hours of patient admission were tracked and compared before and after system implementation.

Results: The existing medication reconciliation process deviated from the hospital guidelines, primarily relying on pharmacists for recording medication data, which was feasible only during office hours. This led to doctors prescribed medication before reconciliation, and causing errors. Developing the E-Medical Reconciliation system and the establishment of new guidelines showed that after the system was implemented in the internal medicine ward, the medication reconciliation rate was 69.8% (target: 60%). The percentage of initial admissions undergoing reconciliation within 24 hours was 75.9% (target: 60%). The discrepancies in prescriptions at levels A-B and C-I significantly decreased (p-value<0.05).

Conclusion: The E-Medical Reconciliation system, developed through interdisciplinary collaboration, resulted in medication reconciliation activities for newly admitted patients and initial admissions receiving reconciliations within 24 hours exceeding the target (60%), and predicted reductions in medication errors at all levels.