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

Hospital admission is high risk for medication harm due to transfer errors, delays, and charting mistakes. Up to 70% of admission medication lists contain errors, 59% potentially harmful, highlighting the need for safety strategies. The aim of the study is to systematically review the effectiveness of strategies for medication management at hospital admission. Following PRISMA guideline, three databases were searched for RCTs. Subgroup analyses assessed outcomes including mortality, readmissions/Emergency Department (ED) visits, length of stay (LOS), medication errors, and adverse drug events (ADEs), with meta-analysis where possible. Nineteen RCTs were included. The strategies were classified into five categories: medication reconciliation, supported medication review, collaborative model of medication review, Partnered Pharmacist Medication Charting (PPMC), and real-time health information exchange (HIE) tools. Medication reconciliation alone showed limited effectiveness in reducing medication errors and ADEs while combining with other strategies was more effective in minimizing ADEs. The meta-analysis showed that PPMC can be considered a potential strategy to reduce medication errors and ADEs. Outcomes such as readmission, ED visits, mortality, and LOS were reported as secondary outcomes, and the strategies showed no significant effect in improving them. Overall admission strategies can reduce medication-related outcomes such as medication errors and ADEs; however, stronger evidence is needed to confirm their impact on other outcomes. Future research should focus on integrating Clinical Decision Support (CDS) and stratification tools into electronic medical records to enhance the efficiency of these tools.