March 23, 2023
2 min read
Schnipper received remuneration from the American Society of Health-System Pharmacists and funding from Synapse Medicine. Please see the study for all other authors’ relevant financial disclosures.
- Medication reconciliation is challenging during care transitions.
- Taking the “best possible medication history” while patients were in the ED reduced medication discrepancy rates in hospitals, researchers said.
A medication reconciliation toolkit offered specific interventions that reduced medication discrepancies during hospitalization, a study published in BMJ Quality and Safety found.
On average, patients experience at least one potentially harmful medication discrepancy — defined as unintentional differences in documented treatment regimens across different care sites — per hospitalization, according to Jeffrey L. Schnipper, MD, a professor of medicine at Brigham and Women’s Hospital, and colleagues.
“This is one of those areas where people just assume hospitals can always do it correctly, but it’s actually pretty difficult in practice,” Schnipper said in a press release. “The average patient coming to a hospital has multiple doctors, is taking several different medications, and may not be consistently taking what they’ve been prescribed.”
Previously, the second Multi-center Medication Reconciliation Quality Improvement Study (MARQUIS2) showed that a toolkit and mentored implementation resulted in a 5% adjusted relative decrease in medication discrepancies per month in hospitals.
For the current study, Schnipper and colleagues further examined the data to identify the most effective components of the toolkit. These components included system-level interventions, such as staff training on medication history, and patient-level interventions, such as taking the “best possible medication history” (BPMH) in the ED before hospital admission.
The The MARQUIS2 study took place across 18 hospitals over an 18-month period. The researchers enrolled 4,947 patients, who had a mean age of 61 years and a mean number of medications of 8.6.
Schnipper and colleagues found that system-level interventions were associated with “modest improvements” in medication discrepancy rates, with relative reductions ranging from 3% to 25%.
Meanwhile, several patient-level interventions were independently associated with large reductions in discrepancy rates, which included:
- BPMH in the ED by a trained clinician (aRR = 0.4; 95% CI, 0.37-0.43);
- BPMH outside the ED by a trained clinician (aRR = 0.68; 95% CI, 0.64-0.73).
- admission medication reconciliation by a trained clinician (aRR = 0.57; 95% CI, 0.5-0.64); and
- discharge medication reconciliation by a trained clinician (aRR = 0.64; 95% CI, 0.57-0.73).
“These findings are consistent with and complement our primary analysis of the MARQUIS2 study, which found that adoption of more system-level interventions over time by itself had little or no effect on discrepancy rates, while receipt of at least one patient-level intervention had a large effect,” the researchers wrote. “Additionally, these analyses suggested likely synergy between the two — for example, once hospitals took actions such as training personnel in how to take a BPMH, then when those trained personnel took a BPMH on a patient, the benefits were that much greater.”
The effectiveness of discharge medication reconciliation was also not a surprise to Schnipper and colleagues.
“Prior studies have shown that reconciliation errors are very common at discharge when preadmission and current inpatient medications must be reconciled with discharge orders,” they wrote. “Targeting this error-prone step would therefore be expected to be high yield.”
Ultimately, “we need to get hospitals focused on taking the best possible medication history in the emergency department, and then doing good discharge medicine reconciliation on top of that, especially for the highest risk patients,” Schnipper said in the release. “Supporting those two efforts would go a long way toward improving patient safety,” he said.
According to the researchers, the toolkit is available for hospitals at no cost.
“We want to scale this up as much as possible, to as many hospitals that are ready for it,” Schnipper said. “That’s where we can make the biggest immediate impact.”