Impact of medication reconciliation and review and counselling, on adverse drug events and healthcare resource use
Background Adverse drug events from preventable medication errors can result in patient morbidity and mortality, and in cost to the healthcare system. Medication reconciliation can improve communication and reduce medication errors at transitions in care. Objective Evaluate the impact of medication reconciliation and counselling intervention delivered by a pharmacist for medical patients on clinical outcomes 30 days after discharge. Setting Sultan Qaboos University Hospital, Muscat, Oman. Methods A randomized controlled study comparing standard care with an intervention delivered by a pharmacist and comprising medication reconciliation on admission and discharge, a medication review, a bedside medication counselling, and a take-home medication list. Medication discrepancies during hospitalization were identified and reconciled. Clinical outcomes were evaluated by reviewing electronic health records and telephone interviews. Main outcome measures Rates of preventable adverse drug events as primary outcome and healthcare resource utilization as secondary outcome at 30 days post discharge. Results A total of 587 patients were recruited (56 ± 17 years, 57% female); 286 randomized to intervention; 301 in the standard care group. In intervention arm, 74 (26%) patients had at least one discrepancy on admission and 100 (35%) on discharge. Rates of preventable adverse drug events were significantly lower in intervention arm compared to standard care arm (9.1 vs. 16%, p = 0.009). No significant difference was found in healthcare resource use. Conclusion The implementation of an intervention comprising medication reconciliation and counselling by a pharmacist has significantly reduced the rate of preventable ADEs 30 days post discharge, compared to the standard care. The effect of the intervention on healthcare resource use was insignificant. Pharmacists should be included in decentralized, patient-centred roles. The findings should be interpreted in the context of the study’s limitations.
KeywordsAdverse drug events Healthcare resource use Medication counselling Medication reconciliation Oman Pharmacist
The work was funded by a doctoral grant provided by Sultan Qaboos University’s College of Medicine.
Conflicts of interest
The authors declare that they have no conflicts of interest.
- 5.Rozich JD, Resar RK. Medication safety: one organization’s approach to the challenge. J Clin Outcomes Manag. 2001;8(10):27–34.Google Scholar
- 6.Commission TJ. Hospital national patient safety goals. 2006. https://www.jointcommission.org/assets/1/6/2017_NPSG_HAP_ER.pdf. Accessed 5 Nov 2015.
- 7.(IHI) IfHI. Medication Reconciliation 2011. http://www.ihi.org/knowledge/Pages/Tools/MedicationReconciliationReview.aspx. Accessed 22 Mar 2016.
- 9.Koehler BE, Richter KM, Youngblood L, Cohen BA, Prengler ID, Cheng D, et al. Reduction of 30-day postdischarge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle. J Hosp Med. 2009;4(4):211–8.CrossRefGoogle Scholar
- 14.Kuo GM, Touchette DR, Marinac JS. Drug errors and related interventions reported by United States clinical pharmacists: the American College of Clinical Pharmacy practice-based research network medication error detection, amelioration and prevention study. Pharmacotherapy. 2013;33(3):253–65.CrossRefGoogle Scholar
- 24.Europe PCN. PCNE Statement on medication review 2013. http://www.pcne.org/upload/files/150_20160504_PCNE_MedRevtypes.pdf (2013). Accessed 20 Aug 2017.
- 28.ISMP. ISMP list of high-alert medications in community/ambulatory healthcare. https://www.ismp.org/communityRx/tools/ambulatoryhighalert.asp (2011). Accessed 13 Mar 2016.
- 29.ISMP. ISMP list of high-alert medications in acute care settings. https://www.ismp.org/tools/institutionalhighAlert.asp (2014). Accessed 13 Mar 2016.
- 33.Unroe KT, Pfeiffenberger T, Riegelhaupt S, Jastrzembski J, Lokhnygina Y, Colon-Emeric C. Inpatient medication reconciliation at admission and discharge: a retrospective cohort study of age and other risk factors for medication discrepancies. Am J Geriatr Pharmacother. 2010;8(2):115–26.CrossRefGoogle Scholar
- 39.Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008;16(2):CD000011.Google Scholar
- 41.Hellstrom LM, Hoglund P, Bondesson A, Petersson G, Eriksson T. Clinical implementation of systematic medication reconciliation and review as part of the Lund Integrated Medicines Management model—impact on all-cause emergency department revisits. J Clin Pharm Ther. 2012;37(6):686–92.CrossRefGoogle Scholar
- 42.Walker PC, Bernstein SJ, Jones JN, Piersma J, Kim HW, Regal RE, et al. Impact of a pharmacist-facilitated hospital discharge program: a quasi-experimental study. Arch Intern Med. [Comment Research Support, Non-U.S. Gov’t]. 2009;169(21):2003–10.Google Scholar