Medication Reconciliation Reduces Risk for Discrepancy

Emma Hitt, PhD

June 26, 2012

June 26, 2012 — Medication reconciliation interventions involving pharmacy staff and targeted intervention to high-risk patients can reduce errors and adverse drug events, according to a newly published systematic review.

Stephanie K. Mueller, MD, from the Brigham and Women's Hospital Hospitalist Service and Division of General Medicine, Harvard Medical School, Boston, Massachusetts, and colleagues reported their findings in an article published online June 25 in the Archives of Internal Medicine.

According to the authors, medication discrepancies occur in up to 70% of patients at hospital admission or discharge, with nearly one third having the potential to cause patient harm (ie, adverse drug events). Moreover, adverse drug events associated with medication discrepancies can increase hospital stays, and when they occur in the postdischarge period, they can lead to emergency department visits and hospital readmissions.

"Medication reconciliation is a strategy for reducing the occurrence of medication discrepancies that may lead to [adverse drug events]," they write.

Dr. Mueller and colleagues sought to summarize study findings on medication reconciliation in the hospital setting and to identify the most effective practices.

They searched MEDLINE and also performed manual searches of studies conducted between 1966 and 2012. Controlled intervention studies were included if medication reconciliation was the primary intervention focus and the intervention occurred in the hospital or during transition.

They identified 26 studies that met the review criteria and grouped them into categories, first based on component of intervention (pharmacist-related, information technology–related, or other type), and then by reported outcomes (medication discrepancies, potential adverse drug events, adverse drug events, and healthcare use).

Studies consistently demonstrated a reduction in medication discrepancies (17/17 studies), potential adverse drug events (5/6 studies), and adverse drug events (2/2 studies), but showed an inconsistent reduction in postdischarge healthcare use (improvement in only 2 of 8 studies).

In addition, the researchers found that heavy involvement of the pharmacy staff and specific focus on high-risk patient populations increased the success of interventions.

Dr. Mueller and colleagues noted that most pharmacist-related interventions included an accurate medication history at the time of admission and could be necessary for successful medication reconciliation.

The authors acknowledge the scarcity of studies comparing different inpatient medication reconciliation practices and their effects on patient outcomes. However, they conclude that medication reconciliation interventions are effective at reducing potential adverse drug events and adverse drug events, especially if interventions use pharmacy staff and target high-risk patients.

In an invited commentary, Peter J. Kaboli, MD, and Olavo Fernandes, PharmD, outlined 4 specific aspects of the medication reconciliation process that could be particularly effective at reducing adverse events: preadmission medication lists, skilled interviewers to complete medication histories, focusing effort on transitions of care, and targeted interventions to maintain cost-effectiveness.

They point out that "[i]mplementing medication reconciliation in inpatient care is a complex...ongoing process" that must be performed without additional staff or salaries.

Dr. Kaboli is from the VA Medical Center, University of Iowa, Iowa City, and Dr. Fernandes is from the University of Toronto in Ontario, Canada.

The study was not commercially supported. The authors and invited commentators have disclosed no relevant financial relationships.

Arch Intern Med. Published online June 25, 2012. Article full text, Commentary full text