Medication discrepancies, defined as unexplained differences in documented medication regimens across different sites of care, are prevalent and an important contributor to adverse drug events (ADEs) among hospitalized and recently discharged patients. In 2006, Partners Healthcare designed an electronic tool to assist with the medication reconciliation process and implemented the tool in 2 academic hospitals along with process redesign in the roles of residents, nurses, and pharmacists. Our previous evaluation with version 1 of the tool demonstrated a 28% relative risk reduction in potentially harmful medication discrepancies (a type of potential ADE) compared with usual care. However, medication discrepancies persisted, use of the tool was only fair, and limitations in the tool remained. The goal of the present study was to evaluate the impact of changes to the medication reconciliation application on medication safety.
Improvements to the medication reconciliation application in 2007 (version 2) included: (1) tight integration with admission medication order entry, such that a preadmission medication selected to be continued at admission now created an order; and (2) a “hard stop” blocking nonurgent medication orders by the primary care team more than 24 hours after admission if a preadmission medication list (PAML) had not been built. We identified potential ADEs (PADEs) as in our prior study: study pharmacists took a gold‐standard medication history, compared that list to admission and discharge orders, and recorded any unexplained differences. Two blinded physician adjudicators then assessed all outcomes, including the presence of a medication discrepancy, potential lor harm, and reason for the error, The primary outcome was the number of PADEs per patient during the 2 time periods (i.e., version 2 vs. version 1 of the application), compared using Poisson regression.
For version 2, we evaluated 283 patients (143 at site 1 and 140 at site 2). Compliance with version 2 (from October 2007 to February 2008) was greater than with version 1 (from May to June 2006): the proportion of PAMLs built within 24 hours of admission increased from 46% to 89% (P < 0.01), The number of PADEs per patient decreased from 1.05 to 0.28 per patient (73% relative risk reduction, P < 0.01). Reductions in PADEs were due to improvements in medication histories at admission and in reconciling medications at discharge.
Improvements in our electronic medication reconciliation tool (improved integration with clinician workflow and implementation of a “hard stop” to encourage utilization), coupled with greater acceptance of the tool with time, led to a large reduction in PADEs. Our study demonstrates the benefits of electronic medication reconciliation tools when coupled with process redesign and provides specific lessons for the design and local implementation of such tools at other institutions.
J. Schnipper, Brigham & Women's Hospital, employment; C. Hamann, Massachusetts General Hospital employment; A. Karson, Massachusetts General Hospital, employment; M. Gleit Carty, Brigham & Women's Hospital, employment; C. Liang, Brigham & Women's Hospital, employment; A. Turehin, Brigham & Women's Hospital, employment; T. Gandhi, Brigham & Women's Hospital, employment; I. Bhan, Massachusetts General Hospital, employment.
To cite this abstract:Schnipper J, Hamann C, Karson A, Carty M, Liang C, Bhan I, Turchin A, Gandhi T. Assessment of Improvements to IT‐Based Medication Reconciliation. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 128. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/assessment-of-improvements-to-itbased-medication-reconciliation/. Accessed July 17, 2019.