What is the Impact of Medication Reconciliation?

The medication reconciliation process is a cost-effective strategy to reduce medication discrepancies and potential adverse drug events (ADEs) as patients move through interfaces of care.

• Hospital Admission — General Medicine. Cornish et al.1 found that 54% of the patients (n= 151, prescribed at least four medications) who were admitted to a general medicine ward in a tertiary care teaching hospital had at least one unintended discrepancy. In this study, 39% of discrepancies were judged to have the potential to cause moderate to severe discomfort or clinical deterioration. The most common discrepancy (46%) consisted of the omission of a regularly used medication.
• Hospital Admission — Emergency Department. In a community hospital, Vira and colleagues2 assessed the potential impact of medication reconciliation in 60 randomly selected patients who were prospectively enrolled at the time of hospital admission. Overall, 60% of the patients had at least one unintended variance (discrepancy) between their admission orders and the medications they were taking at home and 18% had at least one clinically important variance. None of the variances had been detected by usual clinical practice before formal reconciliation was conducted.
• Hospital Discharge. Forster et al.3 found that 23% of hospitalized internal medicine patients discharged from an acute care teaching hospital experienced an adverse event; of that 23%, 72% were adverse drug events.
• Hospital Admission — Surgery. Kwan et al.4 conducted a randomized controlled trial with 464 surgical patients at an acute care teaching hospital. Results demonstrated that multidisciplinary medication reconciliation (pharmacists, nurses and physicians partnering proactively with the patient) in a preadmission clinic resulted in a 50% reduction in the number of patients with discrepancies linked to home medications. Furthermore, the collaborative intervention also resulted in more than halving the number of patients with discrepancies with the potential to cause possible or probable harm compared to standard of care (29.9% vs. 12.9%).
• Cost-effectiveness. Karnon and colleagues5 conducted a model-based cost-effectiveness analysis of interventions aimed at preventing medication errors at hospital admission with medication reconciliation. The aim of the study was to assess the incremental costs and effects (measured as quality adjusted life years) of a range of medication reconciliation interventions. Findings demonstrated that all five interventions, for which evidence of effectiveness was identified, were estimated to be extremely cost effective when compared to the baseline scenario. In this paper, the pharmacist-led reconciliation intervention had the highest expected net benefits and a probability of being cost-effective of over 60% by a quality-adjusted life year value of £ 10 000.
• Healthcare Professional Workload. There is evidence that a successful medication reconciliation process can reduce workload and rework associated with patient medication management. After implementation, nursing time at admission was reduced by over 20 minutes per patient. The amount of time pharmacists were involved in patient discharge was reduced by over 40 minutes.6