Janice L. Kwan*, MD; Lisha Lo*, MPH; Margaret Sampson, MLIS, PhD; Kaveh G. Shojania, MD
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Disclaimer: All statements expressed in this work are those of the authors and should not be construed as official opinions or positions of the organizations where any of the authors are employed, the Agency for Healthcare Research and Quality, or the U.S. Department of Health and Human Services.
Financial Support: From the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services (contract HHSA-290-2007-10062I).
Potential Conflicts of Interest: Dr. Shojania: Other: Agency for Healthcare Research and Quality as a subcontract from the University of California, Los Angeles-RAND Evidence-Based Practice Centre. All other authors have no disclosures. Disclosures can also be viewed atwww.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2634.
Requests for Single Reprints: Kaveh G. Shojania, MD, Department of Medicine, Sunnybrook Health Sciences Centre, Room H468, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Kwan: Department of Medicine, Mount Sinai Hospital, Room 427, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada.
Ms. Lo: University of Toronto Centre for Patient Safety, 525 University Avenue, Room 630, Toronto, Ontario M5G 2L3, Canada.
Dr. Sampson: Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1, Canada.
Dr. Shojania: Department of Medicine, Sunnybrook Health Sciences Centre, Room H468, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
Author Contributions: Conception and design: J.L. Kwan, M. Sampson, K.G. Shojania.
Analysis and interpretation of the data: J.L. Kwan, L. Lo, M. Sampson, K.G. Shojania.
Drafting of the article: J.L. Kwan, L. Lo, M. Sampson, K.G. Shojania.
Critical revision of the article for important intellectual content: J.L. Kwan, L. Lo, K.G. Shojania.
Final approval of the article: J.L. Kwan, M. Sampson, K.G. Shojania.
Statistical expertise: L. Lo, K.G. Shojania.
Obtaining of funding: K.G. Shojania.
Administrative, technical, or logistic support: L. Lo, K.G. Shojania.
Collection and assembly of data: J.L. Kwan, L. Lo, M. Sampson, K.G. Shojania.
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.
Overview of medication reconciliation in acute care.
Adapted, with permission, from Fernandes OA. Medication reconciliation. Pharmacy Practice. 2009;25:26.
Appendix Table. Studies of Medication Reconciliation, Including Assessment of Clinically Significant Unintended Discrepancies and Emergency Department Visits and Hospitalizations Within 30 Days of Discharge
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Bruno Michel, Bénédicte Gourieux,Emmanuel Andres
Departments of Pharmacy (Drs Michel and Gourieux) and Internal Medicine, Diabetes, and Metabolic Disorders (Dr Andres), Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
September 4, 2013
Assessment of potential clinical impact of unintended discrepancies and medication reconciliation
We read with interest the excellent article by JL Kwan; L Lo and colleagues about Medication Reconciliation During Transitions of Care as a Patient Safety Strategy1. We would like to offer some elements about our own experience. The evaluation of the potential clinical impact of the unintended discrepancies identified and corrected during medication reconciliation process is particularly of high interest. Recently, we have set up medication reconciliation at admission within our hospital and estimated in parallel the potential clinical significance of identified unintended medication discrepancies by using a 3-category scale: level 1 “no potential harm”; level 2, “monitoring or intervention potentially required to preclude harm”; and level 3, “potential harm”2.
On the basis of 256 patients, our results showed that 27.2% of the 16 unintended discrepancies (n = 173) were judged to be of clinical importance, indicating that they had the potential to cause patient harm (level 3, 6.4%) or the potential to require a greater patient supervision (level 2, 21.8%). Potential harm was driven by the type of errors (e.g. omission, incorrect medication prescription), by the type of medication classes and the number of medications per patient, and by the clinical characteristics of the patients. These results can be added to those cited by Kwan et al 1. They reported in their review (studies carried out in the United States of America or Canada) that proportion of unintended medication discrepancies with the potential for harm ranges from 11 % to 59 of all discrepancies. This wide range in results may be due to the fact that different patient populations and evaluation methods were used. We recognize that the validity of any method for scoring the potential clinical significance of unintended medication discrepancies is difficult to assess because there is currently no gold standard with which to compare. Nevertheless, all of the studies confirm that medication discrepancies have the potential to cause deterioration in patients’ clinical status and encourage pharmacists and clinicians to identify the most effective practices to avoid them across the continuum of care.
1. Kwan JL., Lo L., M Sampson and KG Shojania: Medication Reconciliation During Transitions of Care as a Patient Safety Strategy: A Systematic Review. Ann Intern Med. 2013; 158:397-403.
2. Quélennec B., Beretz L., Paya D., Blicklé JF., Gourieux B., Andrès E., Michel B : Potential clinical impact of medication discrepancies at hospital admission. Eur J Intern Med. 2013 Mar 18. doi:pii: S0953-6205(13)00050-2. 10.1016/j.ejim.2013.02.007
Correspondence: Dr Michel, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Service de Pharmacie, 1 Ave Molière BP 83 049, 67098 Strasbourg CEDEX, France (email@example.com).
The study mentioned above is part of the Medication Reconciliation (MEDREC) project of the High 5s initiative supported by the World Health Organization (WHO), World Alliance for Patient Safety and coordinated in France by HAS (the French National Authority for Health) and OMEDIT Aquitaine (an observatory of medicines and medical devices located in Aquitaine, France).
Kwan* JL, Lo* L, Sampson M, Shojania KG. Medication Reconciliation During Transitions of Care as a Patient Safety Strategy: A Systematic Review. Ann Intern Med. ;158:397–403. doi: 10.7326/0003-4819-158-5-201303051-00006
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Published: Ann Intern Med. 2013;158(5_Part_2):397-403.
Healthcare Delivery and Policy, Hospital Medicine.
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