Author, Year | Country, Setting | Study design | Participant size | Target of transition | Components of intervention | Length of study | Medications assessed | Verification of discrepancy | Main results |
---|---|---|---|---|---|---|---|---|---|
Agrawal 2009 [35] | USA, Tertiary care academic hospital | Pre-post | 19,476 patients | Admission | Multidisciplinary admission medication reconciliation, computerized reminder alert | 17 ½ months | Prescription and non-prescription medications | Yes | At least 1 unintended discrepancy: 20 % (Pre) vs. 1.4 % (Post) |
Drug omission was the most common type of discrepancy in both phases | |||||||||
Allison 2015 [36] | USA, Academic tertiary care facility | Pre-post | 200 patients | Discharge | Electronic discharge medication reconciliation, staff training | NR | Antibiotics | Yes | At least 1 antibiotic error: 23Â % (Pre) vs. 11Â % (Post) |
Percentage of medications with errors: 30Â % (Pre) vs. 15Â % (Post) | |||||||||
Dosage errors were the most common type of medication error in both phases | |||||||||
Boockvar 2010 [37] | USA, Three academic centers | NRCT | 469 patients | Nursing home to hospital transfer (admission) | Structured review | NR | Prescription medications | Yes | No difference, with and without EHR, in medication discrepancies (mean difference 0.02; 95 % CI - 0.81 to 0.85) and a high-risk discrepancies (mean difference −0.18; 95 % CI −0.22 to 0.58) per hospitalization episode, and an ADE caused by a medication discrepancy (OR 0.96; 95 % CI 0.18 to 5.01) |
46Â % of prescribing discrepancies resulted in ADEs were due to drug omissions | |||||||||
Gimeneze- Manzorro 2011 [42] | Spain, Tertiary care hospital | Pre-post | 3,781 medications | Admission | Computerized reconciliation tool integrated in a CPOE program | 6Â months | NR | Yes | Percentage of medications with discrepancies: 7.24Â % (Pre) vs. 4.18Â % (Post) |
Drug omission was the most frequent unintended discrepancy in both phases | |||||||||
Omission errors: 5.8Â % (Pre) vs. 3.4Â % (Post) | |||||||||
Gimeneze- Manzorro 2015 [43] | Spain, University general hospital | Pre-post | 191 patients | Admission | Nurses gather BPMH via an electronic reconciliation tool, use of CPOE | 6Â months | Prescription medications | Yes | At least 1 unintended discrepancy: 40.2Â % (Pre) vs. 38.1Â % (Post) |
Medications with unintended discrepancies: 10.6Â % (Pre) vs. 6.6Â % (Post) | |||||||||
Of all unintended discrepancies, 144 (86.2Â %) were due to drug omissions | |||||||||
Omission errors: 9.2Â % (Pre) vs. 5.6Â % (Post) | |||||||||
Kramer 2007 [38] | USA, General medical unit | Pre-post | 283 patients | Admission, discharge | Pharmacists and nurses collaborated to electronically complete admission and discharge medication reconciliation, discharge medication counselling | 13Â months | Prescription, non-prescription and herbal supplements | No | Post-implementation, patients took significantly more prescription and nonprescription medications. |
Murphy 2009 [39] | USA, Academic medical center | Pre-post | SU, 149 discharges; MU, 134 discharges | Admission, discharge | Multidisciplinary MedRec using an electronic tool | 2 ½ months | Prescription and non-prescription medications | Yes | Percentage of medications with unintended discrepancies: 90 % (Pre) vs. 47 % (Post) [SU]; 57 % (Pre) vs. 33 % (Post) [MU] |
On the surgical unit, omitted home medications (reduced from 21Â % of orders to 0Â %), omitted inpatient medications (from 8 to 1Â %) and in the medical unit, omitted home and inpatient medications were both reduced from 11 to 0Â %. | |||||||||
Schnipper 2009 [40] | USA, Two academic hospitals | RCT | 322 patients | Admission, discharge | IT designed MedRec integrated into the CPOE system, interdisciplinary medication reconciliation intervention comprising novel IT and process re-design, supportive roles (e.g. training) | NR | NR | Yes | Mean number of medication discrepancies with a potential for harm per patient: 1.44 (C) vs. 1.05 (I) [RR 0.72 (0.52–0.99)] |
Poole 2006 [41] | USA, Community hospital | Pre-post | 100 patients | Discharge | Formation of a medication list from pre-existing electronic sources and reconciliation of discharge medications with this list | 6Â months | prescription medications | Yes | Statistically significant improvement with intervention vs. control in at least 1 outcome in this category; i.e., drug frequency, dose and therapeutic duplication |
Resolution of discrepancies in frequency increased by 65Â % | |||||||||
Resolution of discrepancies in dosages improved by 60Â % | |||||||||
Resolution of therapeutic duplication was addressed in 58Â % of cases | |||||||||
Zoni 2012 [44] | Spain, University general hospital | Pre-post | 162 patients | Admission | IT-designed MedRec, clinical sessions and training | 12Â months | Regular medications, OTC and homeopathic products | Yes | Percentage of medications with unintended discrepancies:3.5Â % (Pre) vs. 1.8Â % (Post) |
At least 1 unintended discrepancy: 23.7Â % (Pre) vs. 14.6Â % (Post) | |||||||||
Drug omission was the most common unintended discrepancy | |||||||||
Omission error: 2.6Â % (Post) vs. 2Â % (Pre) |