Research Activities, August 2013
The effect of medication reconciliation on medication discrepancies is unclear
Patient Safety and Quality
Transitions in care, such as admission to or discharge from the hospital or between hospital units, puts patients at risk for errors due to poor communication and inadvertent information loss. Unintended medication discrepancies remain common at discharge. The formal process for identifying and correcting medication discrepancies across transitions of care, medication reconciliation, has been widely endorsed and is mandated by health care accreditation bodies in the United States and Canada. Yet, most unintentional medication discrepancies found during medication reconciliation have no clinical significance, according to a new study.
The researchers conducted a systematic literature review focusing on the effect of medication reconciliation on unintentional discrepancies with the potential for harm. Discrepancies were only considered clinically significant if they posed a nontrivial risk of harm to patients.
All included studies reported a category that amounted to "trivial," "minor," or "unlikely to cause harm," with all other unintentional discrepancies deemed to be clinically significant. The researchers included 18 studies evaluating 20 hospital-based medication reconciliation interventions, with pharmacists performing medication reconciliation in 17 of the 20 interventions. Their review suggests that only a few unintended discrepancies have clinical significance. Furthermore, most patients have no unintentional discrepancies. Therefore, the actual effect of medication reconciliation on reducing clinically significant discrepancies in the inpatient setting remains unclear.
The researchers point out that while medication reconciliation alone probably does not reduce post-discharge hospital use, it may do so when bundled with interventions aimed at improving care transitions. They also caution that there may be a need to consider a longer window of observation than 30 days in order to demonstrate the benefits of medication reconciliation. This study was supported by AHRQ (Contract No. 290-07-10062).
See "Medication reconciliation during transitions of care as a patient safety strategy," by Janice L. Kwan, M.D., Lisha Lo, M.P.H., Margaret Sampson, Ph.D., and Kaveh G. Shojania, M.D. in the March 5, 2013, Annals of Internal Medicine 158(5) Part 2, pp. 397-403.