Impact of Discharge Medication Reconciliation Across a Five-Hospital Health System

Abstract

Purpose:Hospital readmission of a primary diagnosis can have a substantial financial impact via reductions in reimbursement rates up to 3%, and have a negative impact on the lives of patients. Discharge medication reconciliation (DMR) can reduce medication errors that play a role in readmission. The objective of this study is to evaluate the impact of expanding pharmacist-led DMR across a four hospital health system on 30-day readmission rate for high risk of readmission disease groups.Methods:During the 3-month period, DMR was performed for patients with at least one of the disease states associated with a high risk for 30-day readmission, including chronic obstructive pulmonary disease, pneumonia, congestive heart failure, or acute myocardial infarction.Results:The 30-day readmission rate for patients with a high risk for readmission disease state significantly decreased from 17.5% to 15.5% in the pre-expansion to postexpansion phase, respectively (p = .003). Discharge medication reconciliation capture rate increased from 28% pre-expansion to 35% postexpansion. After expansion, the number of DMR interventions reported by pharmacists increased 2.93 times.Conclusion:Expansion of pharmacist-led DMR as a form of transitions of care significantly decreased 30-day readmission rate for high risk of readmission disease groups.

Impact of pharmacist‐led discharge medication reconciliation on error and patient harm prevention at a large academic medical center

“…1,2 Pharmacist-led medication reconciliation at discharge (PMRD) has emerged as a potential solution to enhance medication safety by mitigating medication errors and reducing hospital readmissions. [3][4][5][6][7] Hospital discharge is a phase of care in which patients often become more vulnerable due to the absence of monitoring and assistance with medication administration. Previous publications from the Multi-Center Medication Reconciliation Quality Improvement Study have revealed a reduction in potentially harmful discrepancies in admission and discharge orders through a multifaceted medication reconciliation implementation model.…”

“…Medication discrepancies and errors occurring during hospital discharge represent a critical concern, posing significant risks such as adverse patient outcomes, medication‐related readmissions, and increased health care costs 1,2 . Pharmacist‐led medication reconciliation at discharge (PMRD) has emerged as a potential solution to enhance medication safety by mitigating medication errors and reducing hospital readmissions 3–7 …”