Medication reconciliation practices in ambulatory cancer care across Canada

248 Background: Substantial work has been done to implement medication reconciliation (MedRec) in the inpatient setting to reduce medical errors and drug discrepancies. However, this work has not extended to the ambulatory cancer setting, where care spans multiple providers and responsibility remains unclear. We undertook an environmental scan to understand current MedRec practices in ambulatory cancer care across Canada. Methods: Semi-structured telephone interviews were conducted with stakeholders from institutions across Canada during a 2-month period in 2019. Questionnaires were pre-circulated to participants to guide discussions. Questions probed participants on processes, policies, roles and responsibilities, definitions of target populations, information sources, and barriers and facilitators. Results: 21 of the 23 stakeholders contacted were interviewed, representing 9 of 10 Provinces. Most institutions had a process in place for collecting best possible medication history (BPMH; 81%); however, considerable variation in practice was noted and full MedRec was uncommon. Of those institutions with a process, BPMH was most often undertaken by a pharmacist or pharmacy tech (53%) using a comprehensive Provincial drug information system (65%) as a starting point, and targeted patients initiating systemic therapy (59%). Few institutions (22%) routinely collected performance measures evaluating the process or outcomes. Lack of resources (physical, human and financial), high patient volumes, and access to medication records from external institutions and community pharmacies were identified as significant barriers to routinely collecting BPMH. Understanding the value added, clinician buy-in, and patient education regarding the importance of bringing medication to the clinic were identified as facilitators. Leveraging patients to more actively participate in collection and maintenance of their own medication records was identified as an area for future work. Conclusions: While most centres were doing BPMH in some patients, MedRec was uncommon in the ambulatory cancer setting. Results indicate a lack of consensus regarding best practices for medication management in ambulatory cancer care.