The Benefits of Medication Reconciliation Programs


Medication Reconciliation can improve patient safety in patients with complex prescription regimens.

A recent study found there was no difference in the length of hospital stay (LHS) between patients receiving usual care and patients receiving medication reconciliation (MR). However, increased patient safety was noted in MR groups.

MR is a process that evaluates a complete list of medications used by a patient. The main goal of MR is to create an accurate list and eliminate any potentially harmful discrepancies.

The goal of the study was to see if patients in MR groups had shorter LHS than patients who were not in those groups.

A 6-month randomized controlled trial enrolled 133 patients over the age of 18 who were newly admitted to general wards of a southern Brazil public teaching hospital, according to the study, published in Pharmacy Practice.

Patients were randomly assigned a number and were then assigned to either the MR group or a usual care (UC) group.

Patient medical histories were collected within 72 hours of hospital admission by nursing staff and residents in the UC groups, while records were collected by a clinical pharmacist in MR groups.

The number of medications prior to admission and the number of medications prescribed at admission were collected for both groups.

The number of discrepancies and the number of interventions completed and accepted were only collected for the MR groups.

UC groups received standard care at the time of admission.

The first part of the MR group’s process was a clinical interview where the above information was gathered.

The second part of the process was a comparison of medication history with admission order, classification, and documentation of any found discrepancies.

The last part of the process was communication and documentation of discrepancies and the patient’s medication list was updated.

Suggestions were then given to physicians about changes in the patient’s pharmacotherapy based on any observed discrepancies.

Then, a written action plan and the list of medications from data collection were attached to the patient’s medical chart.

Researchers observed 2 main types of discrepancies. The first was intentional discrepancies due to an intentional change in pharmacotherapy.

The second was unintentional discrepancies that were due to medication errors. The errors documented were omission, dosage, interval, and route.

Data suggested a correlation between unintentional discrepancies, age, and number of medications a patient is taking prior to admission.

Researchers found that elderly patients taking multiple medications were more likely to have unintentional discrepancies. The severity of their condition could also lead to a higher number of discrepancies, and consequently, a higher risk of adverse events.

According to the study, 64% of patients had at least 1 discrepancy at admission and 59.9% of unintentional discrepancies fell under the omission category.

Researchers attributed this to polymedicated patients who may have forgotten to include medication.

As expected, there was a higher number of unintentional discrepancies in the MR group. The MR group had 327 discrepancies and 52.6% of them were unintentional.

Interventions were only conducted with unintentional discrepancies to adjust dosage, start medications, etc.

Due to the high number of reported omissions, the most frequent intervention was the suggestion of starting a medication, which was accepted by physicians 83.5% of the time.

There was an 89.5% rate for acceptance of adjusting the interval of medication. Adjusting a patient’s dosage was accepted at a rate of 61.5%, while changing the route was only accepted 18.1% of the time.

Overall, physicians accepted about 75% of suggested interventions.

Though researchers were able to show improvements in patient health and safety in MR groups, they were not able to meet the primary outcome of the study since they did not find any difference in LHS between the 2 groups, the study concluded.

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