Medication Reconciliation During Transitions of Care as a Patient Safety Strategy

Annals of internal medicine (Impact Factor: 17.81). 03/2013; 158(5 Pt 2):397-403. DOI: 10.7326/0003-4819-158-5-201303051-00006
Source: PubMed


Medication reconciliation identifies and resolves unintentional discrepancies between patients' medication lists across transitions in care. The purpose of this review is to summarize evidence about the effectiveness of hospital-based medication reconciliation interventions. Searches encompassed MEDLINE through November 2012 and EMBASE and the Cochrane Central Register of Controlled Trials through July 2012. Eligible studies evaluated the effects of hospital-based medication reconciliation on unintentional discrepancies with nontrivial risks for harm to patients or 30-day postdischarge emergency department visits and readmission. Two reviewers evaluated study eligibility, abstracted data, and assessed study quality.Eighteen studies evaluating 20 interventions met the selection criteria. Pharmacists performed medication reconciliation in 17 of the 20 interventions. Most unintentional discrepancies identified had no clinical significance. Medication reconciliation alone probably does not reduce postdischarge hospital utilization but may do so when bundled with interventions aimed at improving care transitions.

29 Reads
  • Source
    • "Medication reconciliation is a powerful process to intercept and correct medication errors (ME) resulting from incomplete or miscommunicated information during transitions of care (hospital admission, transfer and discharge) [1]. At admission, medication reconciliation provides best possible medication histories (BPMH) which reflect accurate "
    [Show abstract] [Hide abstract]
    ABSTRACT: Medication reconciliation is a powerful process to correct medication errors (ME) resulting from miscommunicated information at transitions of care. This study aims to develop and evaluate a scoring method for assessing the severity of potential harm of ME intercepted by medication reconciliation at hospital admission in elderly. The development of the scoring method was based on a literature search and the creation of a list of high-risk drugs used in outpatient care. The evaluation of the method was carried out in 7 French hospitals and was based on two criteria: the inter-rater reliability and acceptability. The assessment of the inter-rater reliability was based on intra-class correlation coefficient (ICC) calculations. Each hospital prospectively enrolled the 10 first patients aged 65 or older presenting with at least one ME. Seven blocks of 10 patients were formed. After randomization, each block was rated by practitioners from 3 hospitals. The assessment of the acceptability was based on a satisfaction questionnaire. A clinical algorithm was developed. The inter-rater reliability of the method was validated by the overall agreement of the 7 hospitals ratings. The agreement was at least substantial (ICC>0.60) and in most of cases almost perfect (ICC>0.80). The acceptability of the method was judged as satisfactory. This multi-centre project has validated an instrument for assessing the severity of potential harm of ME intercepted by medication reconciliation. This will allow studies to be conducted with large cohorts of patients in order to develop epidemiological databases of ME of potential clinical significance. Copyright © 2015. Published by Elsevier B.V.
    European Journal of Internal Medicine 07/2015; 26(7). DOI:10.1016/j.ejim.2015.07.014 · 2.89 Impact Factor
  • Source
    • "A systematic review of medication reconciliation interventions done by pharmacists at the time of hospital discharge did not show a significant reduction in rehospitalizations within 30 days of discharge. The researchers suggested that medication reconciliation may need to be accompanied by other interventions targeted at reducing rehospitalizations to make an impact (Kwan et al., 2013). Bellone et al. (2012) evaluated the difference in rehospitalizations between patients who saw a pharmacist in an ambulatory clinic after hospital discharge compared to those who did not. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Medication regimens can be complicated during the transition from hospital to home for a variety of reasons. The primary purpose of this retrospective study was to measure the impact of integrating a pharmacist into a model of care at a Medicare-certified home healthcare agency for clients recently discharged from the hospital. The secondary purpose was to describe the medication-related problems among clients receiving services from the model of care involving a pharmacist. Integrating a pharmacist within the model of care demonstrated a positive clinical impact on clients.
    Home healthcare nurse 03/2014; 32(3):146-52. DOI:10.1097/NHH.0000000000000024
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives Research conducted by the European Association of Hospital Pharmacists (EAHP), in collaboration with the EuroPharm Forum, investigated the following: the extent to which pharmacists are in contact with each other; the opinions of pharmacists as to the extent to which continuous care is being achieved; and what are the perceived obstacles in this area.Methods A questionnaire was circulated electronically to the respective memberships of both organisations, and was open from 5 December 2012 to 5 February 2013.Results 534 responses were received, 400 (75%) from hospital pharmacists, 106 (20%) from community pharmacists and 28 (5%) from pharmacists working in both sectors. Most replies came from Italy (183, 34%), Denmark (78, 14%) and the UK (33, 5%). Pharmacists described communication as important or very important (hospital pharmacists (212, 53%), community pharmacists (60, 57%)) at admission. Hospital pharmacists thought that communication was either very important or important to a greater degree than community pharmacists (236, 59% vs 50, 47%) at discharge. 27% (108) of hospital pharmacists reported that they had been in contact with a community colleague ‘last week’. Conversely, over half of community pharmacists replied that they had ‘never’ been in contact with a hospital pharmacist.Limitations Sample size may not be representative, and the role of pharmacy technicians was not included. These results should be interpreted with caution due to the descriptive nature and lack of statistical analysis.Conclusions Communication between the two sectors is infrequent, yet pharmacists feel it is important, especially at transitions of care. Integrated IT systems and improved remuneration systems for clinical services may improve this aspect.
    European Journal of Hospital Pharmacy 02/2013; 21(2-2):79-83. DOI:10.1136/ejhpharm-2013-000374 · 0.43 Impact Factor
Show more