Medication reconciliation for reducing drug-discrepancy adverse events

Area of Science:

• Health Services Research
• Patient Safety
• Pharmacology

Background:

• Medication reconciliation is crucial for preventing medication errors by identifying discrepancies in drug regimens across care transitions.
• Adverse drug events (ADEs) are a significant concern for patients moving between hospital and nursing home settings.

Purpose of the Study:

• To evaluate the impact of pharmacist-conducted medication reconciliation on discrepancy-related ADEs in nursing home residents after hospital discharge.
• To assess the effectiveness of pharmacist interventions in improving medication safety during care transitions.

Main Methods:

• A preintervention/postintervention study design was employed in a large urban nursing home.
• Pharmacists reconciled medications for residents returning from hospitalization, communicating discrepancies to physicians.
• Adverse drug events were ascertained by independent physician raters reviewing medical records.

Main Results:

• The study involved 168 residents and 259 hospital stays, identifying 696 prescribing discrepancies.
• Pharmacist reconciliation led to a significant reduction in discrepancy-related ADEs, with odds decreasing from 14.5% in the preintervention group to 2.3% in the postintervention group.
• Pain from omitted analgesics and ADEs related to antibiotics and analgesics were most common.

Conclusions:

• Pharmacist-led medication reconciliation effectively reduces discrepancy-related ADEs in patients transitioning between hospital and nursing home settings.
• The findings highlight the importance of pharmacist involvement in medication management during care transitions.
• Further research is needed to optimize reconciliation processes for various care settings.