Medication Reconciliation by Nurse-Pharmacist Teams Highly Cost-Effective

Researchers believe that their program, tested at Johns Hopkins Hospital, has the potential to dramatically reduce the risk of adverse drug events.

A collaborative nurse-pharmacist medication reconciliation program appears to dramatically decrease the risk of adverse drug events (ADEs) at low cost, according to the results of a study published in the May/June 2012 issue of the Journal of Hospital Medicine. The study included 563 patients who were admitted to Johns Hopkins Hospital in Baltimore in 2008 and 2009.

When each patient was admitted, a nurse assembled a list of medications the patient had been taking at home through a patient interview and, if necessary, consultation with an electronic health record, community pharmacist, or primary care provider. The nurse then compared this home medication list (HML) with the patient’s active inpatient medication list and referred discrepancies—including omissions, additions, substitutions, and dosing changes—to a clinical pharmacist. If the pharmacist determined that a discrepancy appeared to be unintentional, the prescriber was notified and if the prescriber made a change to the patient’s medication order, then the discrepancy was classified as unintentional and was rated on a potential harm scale of 1 to 3. This process was repeated for each patient upon discharge.

Of the 563 patients included in the study, 225 patients had at least 1 unintentional medication discrepancy upon admission or discharge, and 162 of these patients had an unintentional discrepancy that was rated at 2 or 3 on the potential harm scale. There were more total unintentional discrepancies upon admission (364) than upon discharge (167), but just 45% of unintentional discrepancies on admission ranked at 2 or 3 on the harm scale, compared with 85% of unintentional discrepancies on discharge. The average number of medications per patient was 7.8, and each additional medication a patient was on increased their risk of unintentional discrepancy by 8.7%.

The cost of the medication reconciliation program was estimated at $31.82 per patient and $113.64 per potentially harmful discrepancy (ie, an unintentional discrepancy rated at 2 or 3 on the potential harm scale). Based on an estimated cost of $9344 per ADE, the researchers note that the program would have to prevent 1 ADE per 290 patients to offset costs. The study’s results show that the program prevented 81 potentially harmful discrepancies per 290 patients, suggesting that just 1.2% of these discrepancies would have to lead to an actual ADE for the cost of the intervention to be offset.

According to the researchers, their study provides a model of an easily replicable, inexpensive method of reducing the risk of ADEs. They note that the method could be made even more cost-effective by focusing on those patients who are most at risk of an unintentional medication discrepancy—those who are taking multiple medications prior to being admitted to the hospital.