Pharmacist provided medicines reconciliation within 24 hours of admission and on discharge: a randomised controlled pilot study

Abstract

BackgroundThe UK government currently recommends that all patients receive medicines reconciliation (MR) from a member of the pharmacy team within 24 hours of admission and subsequent discharge. The cost-effectiveness of this intervention is unknown. A pilot study to inform the design of a future randomised controlled trial to determine effectiveness and cost-effectiveness of a pharmacist-delivered service was undertaken.MethodPatients were recruited 7 days a week from 5 adult medical wards in 1 hospital over a 9 month period and randomised using an automated system to intervention (MR within 24 hours of admission and at discharge) or usual care which may include MR (control). Recruitment and retention rates were determined. Length of stay (LOS), quality of life (EQ-5D-3L), unintentional discrepancies (UDs) and emergency readmission (ER) within 3 months were tested as outcome measures. The feasibility of identifying and measuring intervention-associated resources was determined.Result200 patients were randomised to either intervention or control. Groups were comparable at baseline. 95 (99%) patients in the intervention received MR within 24 hours, while 62 (60.8%) control patients received MR at some point during admission. The intervention resolved 250 of the 255 UDs identified at admission. Only 2 UDs were identified in the intervention group at discharge compared with 268 in the control. The median LOS was 94 hours in the intervention arm and 118 hours in the control, with ER rates of 17.9% and 26.7%, respectively. Assuming 5% loss to follow-up 1120 patients (560 in each arm) are required to detect a 6% reduction in 3-month ER rates.ConclusionsThe results suggest that changes in outcome measures resulting from MR within 24 hours were in the appropriate direction and readmission within 3 months is the most appropriate primary outcome measure. A future study to determine cost-effectiveness of the intervention is feasible and warranted.Trial registration numberISRCTN23949491.

The Introduction of a Full Medication Review Process in a Local Hospital: Successes and Barriers of a Pilot Project in the Geriatric Ward

“…The results show a positive influence of a pharmacist-led medication reconciliation upon admission, which is in line with many previous studies [ 7 , 8 , 25 ]. It also reflects the importance to consult more than one source to obtain information on the patient’s medication history [ 5 ].…”

<p>Hospital-Wide Medication Reconciliation Program: Error Identification, Cost-Effectiveness, and Detecting High-Risk Individuals on Admission</p>

“…The objectives of this study were to 1) measure to what degree a hospital-wide Medication History Technician (MHT) program identifies errors from home medications, 2) prove the cost-effectiveness of this error reduction on a large scale, and 3) identify risk factors placing individual patients at higher risk for medication discrepancies. We expect our institution will demonstrate similar rates of medication discrepancies of 1.1 to 11.5 medication discrepancies per admission seen in other studies 13,14,16,24,25 as well as demonstrate a positive economic impact on our institution. As one of the largest programs of its kind, to our knowledge, a detailed study of the degree of error identification and its financial impact could benefit other healthcare facilities investigating implementation or expansion of pharmacy-led medication history programs.…”

“…Due to the increased opportunity for error and the risk associated with these errors, there is a growing pool of literature on the topic of medication history programs. [2][3][4][5][22][23][24][25][26] Many of these studies focus on emergency department-based pilot programs or individual departments within a hospital; however, there is little data evaluating these programs in a hospital-wide or institution-wide setting. There is also little data on what specific factors place an individual patient at higher risk for medication error upon admission to a hospital.…”

Reducing medication errors in critical care patients: pharmacist key resources and relationship with medicines optimisation

“…Although medicines reconciliation on patient admission is widespread practice as recognised by the group, repeated application on critical care discharge did not make the Top 5 important interventions. Nevertheless, both critical care interface periods are high‐risk periods for medication errors as recently demonstrated by Cadman et al . On hospital discharge, it remains a common problem for patients to continue potentially inappropriate medication and/or not to have important chronic therapy recommenced …”

“…As such, it remains unknown, which combinations of resources are most effective in improving medication safety . Even for interventions demonstrated to reduce medications errors, such as medicines reconciliation, actual delivery of this intervention can be highly variable in practice. The result is an uncoordinated approach to allocation of resources to reduce medication errors across critical care units even within single health systems.…”