Impact of electronic medication reconciliation interventions on medication discrepancies at hospital transitions: a systematic review and meta-analysis

Mekonnen, Alemayehu B.; Abebe, Tamrat B.; McLachlan, Andrew J.; Brien, Jo-anne E.

doi:10.1186/s12911-016-0353-9

BMC Medical Informatics and Decision Making

Table 1 Characteristics of included studies

From: Impact of electronic medication reconciliation interventions on medication discrepancies at hospital transitions: a systematic review and meta-analysis

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)
Agrawal 2009 [35]	USA, Tertiary care academic hospital	Pre-post	19,476 patients	Admission		17 ½ months	Prescription and non-prescription medications	Yes	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: 23 % (Pre) vs. 11 % (Post)
									Percentage of medications with errors: 30 % (Pre) vs. 15 % (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)
Boockvar 2010 [37]	USA, Three academic centers	NRCT	469 patients	Nursing home to hospital transfer (admission)	Structured review	NR	Prescription medications	Yes	46 % 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	6 months	NR	Yes	Percentage of medications with discrepancies: 7.24 % (Pre) vs. 4.18 % (Post)
									Drug omission was the most frequent unintended discrepancy in both phases
									Omission errors: 5.8 % (Pre) vs. 3.4 % (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	6 months	Prescription medications	Yes	At least 1 unintended discrepancy: 40.2 % (Pre) vs. 38.1 % (Post)
									Medications with unintended discrepancies: 10.6 % (Pre) vs. 6.6 % (Post)
									Of all unintended discrepancies, 144 (86.2 %) were due to drug omissions
									Omission errors: 9.2 % (Pre) vs. 5.6 % (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	13 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]
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	On the surgical unit, omitted home medications (reduced from 21 % of orders to 0 %), omitted inpatient medications (from 8 to 1 %) and in the medical unit, omitted home and inpatient medications were both reduced from 11 to 0 %.
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	6 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 65 %
									Resolution of discrepancies in dosages improved by 60 %
									Resolution of therapeutic duplication was addressed in 58 % of cases
Zoni 2012 [44]	Spain, University general hospital	Pre-post	162 patients	Admission	IT-designed MedRec, clinical sessions and training	12 months	Regular medications, OTC and homeopathic products	Yes	Percentage of medications with unintended discrepancies:3.5 % (Pre) vs. 1.8 % (Post)
									At least 1 unintended discrepancy: 23.7 % (Pre) vs. 14.6 % (Post)
									Drug omission was the most common unintended discrepancy
									Omission error: 2.6 % (Post) vs. 2 % (Pre)

ADE adverse drug event, BPMH best possible medication history, CPOE computerized physician order entry, C control, EHR electronic health record, I intervention, IT information technology, MedRec medication reconciliation, MU medical unit, NR not reported, OR odds ratio, OTC over-the-counter, Pre pre-implementation, Post post-implementation, RCT randomized controlled trial, RR relative risk, SU surgical unit

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