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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3006 — Effect of Admission Medication Reconciliation on Adverse Drug Events in Hospitalized Veterans

Boockvar KS (James J Peters VA Medical Center), Yeh J (James J Peters VA Medical Center), Kugler A (Long Island University), Blum S (Brookdale University Hospital), Mergenhagen K (VA Western New York Healthcare System), Sung S (Lutheran Healthcare), Signor D (James J Peters VA Medical Center), Nebeker J (VA Salt Lake City Health Care System), Livote E (James J Peters VA Medical Center)

Objectives:
Medication reconciliation, a process by which a provider obtains and documents a medication history comparing current and previous medication use, has been a focus of national, VA, and international patient safety initiatives. Information on its effect on clinical outcomes has been limited. The objective of this study was to evaluate the effect of inpatient medication reconciliation on adverse drug events (ADEs) and ADE risk.

Methods:
The study was conducted on 2 general inpatient units of an urban, academic VA medical center. An admission medication reconciliation tool and process were developed to comply with the Joint Commission National Patient Safety Goal. Staggered implementation by unit enabled a pre-post unit-based comparison with concurrent control. ADEs caused by admission medication changes were ascertained by structured medical record review by research pharmacists. If an ADE occurred, the pharmacist assigned a score indicating whether it was the result of a prescribing error. The pharmacist also rated each admission prescribing change on a 4-point scale reflecting potential for harm and ratings were summed for an ADE risk score. Multivariable models tested for intervention effect adjusting for age, race, chronic conditions, number of medications, use of non-VA pharmacy, admission to the surgical service, admission between 8pm-6am Mon-Fri, admission illness severity, and study unit.

Results:
Admitted patients were 97.5% male, 66.9 years old on average, 48.2% white, and took a mean of 6.4 medications pre-admission. During 250 of 795 hospitalizations (31.4%) patients experienced at least 1 possible ADE related to an admission medication change. Medication reconciliation was significantly associated with fewer ADEs caused by prescribing errors (odds ratio 0.55; 95% CI 0.35-0.87; p = 0.011), but not total ADEs (odds ratio 0.80; 95% CI 0.58-1.12; p = 0.204). Medication reconciliation was borderline associated with lower ADE risk (coefficient -0.31; 95% CI -0.64-0.01; p = 0.057).

Implications:
Medication reconciliation upon hospital admission is associated with a reduction in ADEs caused by prescribing errors but not overall ADEs.

Impacts:
Medication reconciliation has been difficult to implement for many organizations and is resource intensive. Study findings provide a clearer picture of the size and type of benefit that can be expected from its implementation and can help inform improvement in the process.


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