Impact of a medication history software on a pharmacy-driven admission medication history and reconciliation program

Medication errors frequently occur during transitional periods between outpatient and inpatient care. This study aims to evaluate the impact of an outpatient-interfacing medication history software on medication history capture rates in a pharmacy-driven admission medication history and reconciliation program utilizing a hybrid pharmacy technician staffing model.

This retrospective, single-center, cohort study was conducted at an 880-bed academic medical center. Adult patients admitted between October 22 and November 19, 2024, were evaluated as part of the pre-software implementation period, and those admitted between January 2 and January 30, 2025, were evaluated as part of the post-software implementation period. Analyses were limited to each patient's first admission. The primary endpoint was the percentage of patients who had a medication history completed. Secondary endpoints included 30- and 90-day all-cause readmission rates, the number and types of discrepancies identified on prior-to-admission (PTA) medication lists, and time to completion of a medication history and reconciliation.

The medication history capture rate increased from 67.6% (1,172 of 1,736 admissions) in the preimplementation group to 86.2% (1,416 of 1,643 admissions) in the postimplementation group, representing an 18.6% improvement (P < 0.0001). This improvement occurred despite over 125 fewer staffed hours. There was also an observed improvement in hours from admission to medication history completion (29.05 vs 26.62; P = 0.02). The number and types of medication discrepancies identified remained consistent between groups. No statistically significant differences were observed in 30- or 90-day readmission rates.

Implementation of a healthcare technology that interfaces with outpatient pharmacy systems significantly improved the efficiency and reach of a pharmacy-driven medication history program. These results support the use of automated tools as a strategy to enhance transitional care processes.