Medication Reconciliation is a Defined Five-Step Process (British Medical Journal, 2017):

The medication reconciliation process reduces discrepancies in medication management during transitions between healthcare providers, thereby minimizing the risk of medication-related harm. Efforts are currently underway in Iceland to standardize and enhance this process, with various approaches being tested to improve medication reconciliation:

Hospital Medication Reconciliation Template

A pilot project is underway at Landakot using a structured template to standardize the medication reconciliation process within medical teams. Early results are promising. The goal is to:

• Enable healthcare professionals to have comprehensive discussions with patients about their medication therapy.

• Ensure easy access to the latest medication records and any changes.

• Improve efficiency in coordinating prescribed medications.

The template will later be expanded to all emergency admissions at the National University Hospital of Iceland (LSH) and subsequently introduced to other departments and healthcare institutions.

Clinical Pharmacist Support for Medication Reconciliation

Clinical pharmacist involvement in medication reconciliation at Landspítali is being strengthened. The aim is to ensure that more emergency admissions receive a comprehensive medication reconciliation review by an experienced pharmacist within 24 hours of admission.

Improved access to information on which medicines patients are to take will be developed and tested after solutions aimed at improving the coordination of medicines at Landspitali have been implemented. This will be further developed through the introduction of a centralised medicinal product card through the Patient Health Portal (Heilsuvera).

Transfer from Intensive Care Units (ICU) to Emergency Departments at Landspítali

Improvements are being made to accessibility and formatting of ICU discharge summaries when patients are transferred from ICU at Hringbraut to emergency departments.

• The main challenge is ensuring secure and accurate transfer of information between two teams using different electronic health records (EHR) and medication prescription systems.

• Standardized ICU discharge summary templates have been developed, and solutions are currently being tested to reduce variability in their structure.

• Successful improvements will then be implemented in other hospital departments.

Transfer from Emergency Departments to Geriatric Rehabilitation Units

Older patients who stay for extended periods in emergency departments before being transferred to geriatric rehabilitation units are at a higher risk of medication errors at Landspítali.

• These patients often take multiple medications (>10), and their medication regimens are frequently adjusted during their hospital stay.

• A project has been launched to ensure that all patients receive standardized discharge summaries when moving from emergency to rehabilitation units.

• Templates and methods are being tested in internal medicine wards to encourage physicians to draft discharge summaries earlier in the transition process, rather than at the last minute.

• Once proven effective, these solutions will be expanded to other departments be successful.

The Directorate of Health is working on the development of a centralized electronic medication record. This system will ensure that updated medication prescriptions are stored in one unified location, accessible to all physicians across the country.

A centralized electronic medication record can serve as the foundation for more efficient and accurate medication reconciliation and review.

Currently, the software is being tested offline at a primary healthcare center in Reykjavík.