Study Shows Medication Reconciliation Reduces Adverse Drug Events Related to Some Hospital Admission Prescribing Changes
Patient transfer between sites of care is a regular practice during an episode of illness, but it can be associated with lapses in care, of which medication discrepancies and adverse drug events (ADEs) are among the most common. Medication reconciliation, a process by which a provider obtains and documents a thorough medication history with specific attention to comparing current and previous medication use, has been a focus of major patient safety initiatives. This study estimated the effectiveness of inpatient medication reconciliation at the time of hospital admission on ADEs caused by admission prescribing changes. Investigators developed a CPRS (computerized patient record system) medication reconciliation tool and admission process that was implemented for 612 Veterans admitted to one academic, urban VAMC between 10/05 and 5/06. Using retrospective chart review, the main outcome measured was ADEs that were "probably" or "certainly" caused by an admission medication change.
- Medication reconciliation at the time of hospital admission reduced ADEs caused by admission prescribing changes that were classified as errors by 43%, but it did not reduce ADEs caused by all admission prescribing changes.
- Non-error-related ADEs would not be averted by one-time medication reconciliation on admission, but they might be averted by improved provider awareness and monitoring of admission prescribing changes during the hospital stay. The potential impact of such an intervention is large, as 50% of the ADEs in this study were caused by admission medication changes that were not errors.
- Overall, there were 131 ADEs during 795 patient admissions: 98 (75%) were symptomatic; 6 (4.5%) caused prolonged hospital stays; and 1 (0.8%) required intensive care.
The intervention is included in medication reconciliation solutions posted on the VA National Medication Reconciliation Initiative Sharepoint website.
- The medication reconciliation process during the first three months of implementation did not fit ideally into provider workflow, thus adherence was low.
This study was funded by HSR&D (IAB 05-204). Dr. Boockvar is part of HSR&D’s Center for Research on Health Care across Systems and Sites of Care, Bronx, NY.
Boockvar K, Blum S, Kugler A, et al. Effect of Admission Medication Reconciliation on Adverse Drug Events from Admission Medication Changes. Archives of Internal Medicine May 9, 2011;171(9):860-61.