Improving Patient Safety Through Medication Reconciliation at Care Transitions: A Mixed Methods Systematic Review

Medication reconciliation (MedRec) is a cornerstone patient safety practice during care transitions. However, evidence regarding the specific implementation strategies that contribute to its effectiveness remains limited. This study sought to elucidate the essential ingredients of a Medication Reconciliation Standard Operating Protocol (MedRec SOP) and their impact on enhancing patient safety outcomes compared to usual care.

We conducted a mixed-methods systematic review following PRISMA guidelines. PubMed, Web of Science, and Embase were searched for studies (January 2000-May 2024) assessing MedRec interventions compared to usual care. Data on study design, MedRec SOP components, and patient safety outcomes were extracted. Random-effects meta-analyses were performed for quantitative synthesis.

From 7209 screened records, 70 studies were included, describing 20 distinct MedRec SOP ingredients. Meta-analysis demonstrated that MedRec significantly reduced medication discrepancies (RR = 0.39, 95% CI 0.28-0.53), adverse drug events/reactions (RR = 0.61, 95% CI 0.47-0.79), 30-day all-cause readmissions (RR = 0.73, 95% CI 0.68-0.78), emergency department visits (RR = 0.60, 95% CI 0.52-0.68), and drug-related readmissions (RR = 0.51, 95% CI 0.31-0.84). Subgroup analyses identified pharmacist-led interventions and MedRec performed at hospital admission as particularly effective strategies. The SOP component "MedRec on admission" showed the highest effective ratio (ER = 9.40).

Our systematic review supports the implementation of MedRec programs that include some components aimed at optimizing the MedRec intervention design. MedRec is a promising implementation strategy to improve patient safety and can be incorporated into the healthcare system.

CRD42024491225.