Effect of an Electronic Medication Reconciliation Intervention on Adverse Drug Events

Abstract

Key PointsQuestionDoes an electronic medication reconciliation tool reduce the occurrence of adverse drug events and other adverse outcomes in the 30 days after discharge?FindingsIn this cluster randomized trial that included 3491 patients discharged from 2 medical units and 2 surgical units of 1 academic hospital, electronic medication reconciliation reduced medication discrepancies but had no effect on adverse drug events (primary outcome), emergency department visits, or readmission in the 30 days after discharge.MeaningHospital accreditation requirements for medication reconciliation should be revised to focus on interventions that will reduce the risk of adverse events for patients with multiple changes to their community medication.

Successful care transitions for older people: a systematic review and meta-analysis of the effects of interventions that support medication continuity

“…Studies were conducted in 12 countries covering a range of public and privately funded healthcare systems (see Figure 2 for summary of characteristics). A total of 17,664 participants were enrolled (range, 25 [ 24 ]–4656 participants [ 25 ]) and the sample’s mean age ranged from 66 [ 26 , 27 ] to 86 years [ 28 ] ( Supplementary Material A3 provides full study characteristics).…”

“…Nine studies described intervention bundles provided during hospital admission [ 25 , 27 , 29–35 ], seven of which were delivered by the inpatient pharmacy team and one by geriatricians [ 34 ]. One involved an electronic intervention [ 25 ]. Intervention components were most often delivered once during the inpatient stay.…”

“…Twelve studies scored low in all five risks of bias domains [ 24 , 25 , 28 , 34 , 35 , 38 , 41 , 42 , 44–47 ] (see Supplementary Material A4 ). Nine studies were rated as having the highest risk of bias [ 26 , 27 , 29 , 31 , 33 , 37 , 39 , 40 , 43 ] based on randomisation and allocation concealment methods.…”

“…All three of these interventions included medication review and reconciliation, patient education and transfer of information; however, only Legrain et al .’s study [ 34 ] was considered to be at low risk of bias. Discrepancies in medication were improved by Hockly et al .’s intervention involving transfer of discharge information ( P = 0.00034) [ 27 ], Tamblyn et al .’s medication reconciliation intervention (odds ratio [OR] 0.24; CIs 0.12–0.57) [ 25 ] and Bolas et al .’s intervention ( P < 0.005) [ 31 ] involving education and a personalised medication sheet. Only Tamblyn et al .’s study [ 25 ] was considered to be high quality, with the other studies having selection or detection biases.…”

“…In this review, patient education, reconciliation and timely cross-sector communication were the most widely used activities. Reconciliation, performed manually or via electronic intervention, was shown to significantly reduce hospital readmission (RR 0.88 [0.81, 0.96]) and was linked to fewer medication errors [ 25 , 29 , 31 , 48 ]. The benefits of reconciliation appear highly contested in the literature.…”