Medication Management Strategies at Hospital Admission: A Systematic Review and Meta-Analysis.

Area of Science:

• Health Services Research
• Patient Safety
• Pharmacoeconomics

Background:

• Hospital admissions pose significant risks for medication harm due to errors during transitions.
• Up to 70% of admission medication lists contain errors, with 59% being potentially harmful.

Purpose of the Study:

• To systematically review the effectiveness of medication management strategies implemented during hospital admission.
• To identify interventions that minimize medication errors and adverse drug events (ADEs) at hospital entry.

Main Methods:

• A systematic review following PRISMA guidelines, searching three databases for randomized controlled trials (RCTs).
• Subgroup analyses and meta-analysis were conducted to assess outcomes including mortality, readmissions, Emergency Department (ED) visits, length of stay (LOS), medication errors, and ADEs.
• Nineteen RCTs were included, evaluating strategies like medication reconciliation, supported medication review, collaborative medication review, Partnered Pharmacist Medication Charting (PPMC), and health information exchange (HIE) tools.

Main Results:

• Medication reconciliation alone demonstrated limited effectiveness in reducing medication errors and ADEs.
• Combining medication reconciliation with other strategies proved more effective in minimizing ADEs.
• Meta-analysis indicated that Partnered Pharmacist Medication Charting (PPMC) is a potential strategy for reducing medication errors and ADEs.
• No significant improvements were observed in secondary outcomes such as readmission, ED visits, mortality, and LOS.

Conclusions:

• Current admission medication management strategies can effectively reduce medication errors and ADEs.
• Stronger evidence is required to confirm the impact of these strategies on broader patient outcomes like mortality and readmissions.
• Future research should explore integrating Clinical Decision Support (CDS) tools within electronic medical records to enhance intervention efficiency.