Medication Reconciliation to Prevent ADEs

Adverse drug events (ADEs), which are injuries related to using a drug, occur in 5% to 40% of hospitalized patients and in 12% to 17% of patients following hospital discharge. Transitions of care, including hospital admission and discharge, are common times when ADEs associated with medication discrepancies occur. Medication discrepancies are defined as unexplained differences in documented medication regimens across different sites of care.

It is estimated that medication discrepancies occur in as many as 70% of patients at hospital admission or discharge. According to researchers, nearly one third of those medication discrepancies carry the potential of causing the patient harm. ADEs associated with medication discrepancies may result in longer hospital stays, and, in the postdischarge period, lead to visits to the emergency department, readmission, and increased use of other healthcare resources.

Medication reconciliation is a strategy that involves “identifying the most accurate list of all medications a patient is taking…and using this list to provide correct medications for patients anywhere within the healthcare system.” In 2005, the Joint Commission added medication reconciliation to its list of National Patient Safety Goals.

Researchers recently performed a systematic review of the literature to summarize the available evidence on medication reconciliation in the hospital setting and to identify the most effective practices. They reported results of the review online in Archives of Internal Medicine [doi:10.100/archinternmed.2012.2246].

The researchers utilized MEDLINE (1966 through February 2012) and performed a manual search to find articles on medication reconciliation. Eligible studies were in English and had medication reconciliation as the primary focus of the intervention. These studies also had a defined comparison group, a clearly described intervention, an intervention that was performed during hospitalization or during transition in or out of the hospital, and quantitative results reported.

The initial electronic search revealed 1632 relevant articles. Of those, 173 abstracts were reviewed. A second electronic search and the manual search identified an additional 57 abstracts for review. Of the 230 abstracts reviewed, 80 were given full review; 17 of those met the inclusion criteria. An additional search yielded 9 more articles that met the inclusion criteria, making a total of 26 studies included in the review.

There were 10 randomized controlled trials, 3 nonrandomized trials with a concurrent control group, and 13 pre-post studies. The studies were grouped by type of medication reconciliation intervention (pharmacist-related, information technology [IT], or other) and were assigned quality ratings using US Preventive Services Task Force criteria.

In all, 15 of the studies described pharmacist-related interventions, 6 assessed IT interventions, and 5 evaluated other interventions. All of the studies used usual care as the comparison group; none compared different types of interventions.

There was an inconsistent reduction in postdischarge healthcare utilization in the studies (2 of 8 studies demonstrated improvement), however, 17 of 17 studies found a reduction in medication discrepancies, 5 of 6 found a reduction in potential ADEs, and 2 of 2 found a reduction in ADEs.

The successful interventions included intensive involvement from pharmacy staff. The successful interventions were also targeted to a patient population at high-risk for ADEs (older patients [55 to 80 years of age]; polypharmacy, [>4 to 13 medications]; and >3 comorbid conditions).

“Available evidence supports medication reconciliation interventions that heavily use pharmacy staff and focus on patients at high risk for ADEs. Higher quality studies are needed to determine the most effective approaches to inpatient medication reconciliation," the researchers said.