For years hospitals’ efforts to curb medication errors ignored one of the most important aspects of medication safety: errors which occur at the transitions of care including admission, discharge and transfer from one facility to another. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO, which, by the way, in a week or so will no longer be JCAHO) set out to remedy the problem in an initiative known as medication reconciliation across the continuum of care. Although this, one of their more laudable efforts in some time in my opinion, was announced in 2005 it really got into high gear this year thus deserving mention as one of the top issues of 2006.
Although the concept is simple, implementation seems to have proven difficult judging from some of the forums I read. For many initiatives on patient safety big ideas tend to precede evidence, but in the case of medication reconciliation evidence is already trickling in that the process can save lives.