Summary
Background
During transitions of care, patient’s medications are prone to medication errors. This study evaluated the impact of pharmacist-led medication reconciliation at hospital admission on unintentional medication discrepancies and adverse drug events.
Methods
A randomized controlled clinical trial was conducted in 120 adult medical patients hospitalized in a tertiary hospital in Slovenia. In the intervention group, a pharmacist-led medication reconciliation was performed on admission, while the control group received usual care. Patient’s drug treatment before admission was compared with their admission and inpatient treatment to identify discrepancies. The intention of discrepancies and related adverse drug events were assessed as a consensus of an expert panel.
Results
Included patients were elderly (median 72 years) and treated with polypharmacy (median 7 medications). Upon admission, discrepancies and unintentional discrepancies, representing a medication error, were identified in 61.2% (825/1347) and 18.3% (247/1347) of medications, respectively. In the intervention group, only 29.1% (37/127) of unintentional discrepancies were reported to the physicians in person. The majority of admission discrepancies (88%) persisted through hospitalization. Unintentional discrepancies resulted in 51 adverse drug events even during hospitalization. There were no differences between the intervention and control group in the occurrence of unintentional discrepancies (p = 0.481) or adverse drug events (p = 0.801).
Conclusions
Medication reconciliation at hospital admission failed to reduce unintentional discrepancies and adverse drug events, possibly due to its poor integration into clinical practice. Discrepancies resulted in patient harm even during the short period of hospitalization, which warrants the implementation of medication reconciliation at hospital admission.
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Acknowledgements
The authors would like to thank Anja Primožič and Sara Cimprič for their contribution to data collection, Prof. Mitja Košnik and Prof. Stanislav Šuškovič for their participation in the expert panel, and all participating pharmacists.
Funding
The authors acknowledge the financial support from the Slovenian Research Agency (research core funding No. P1-0189 and P‑0360).
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The study was conceptualized and designed by Lea Knez and Aleš Mrhar. Material preparation, data collection and analysis were performed by Lea Knez, Maja Jošt and Mojca Kerec Kos. The first draft of the manuscript was written by Maja Jošt and all other authors Lea Knez, Aleš Mrhar, Mojca Kerec Kos critically revised the manuscript for the important intellectual content. All authors read and approved the final manuscript.
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M. Jošt, L. Knez, A. Mrhar and M.K. Kos declare that they have no competing interests.
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All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee (National Medical Ethics Committee in Slovenia (Protocol Number 0120-223/2019/4)) and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
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Jošt, M., Knez, L., Mrhar, A. et al. Adverse drug events during transitions of care. Wien Klin Wochenschr 134, 130–138 (2022). https://doi.org/10.1007/s00508-021-01972-2
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DOI: https://doi.org/10.1007/s00508-021-01972-2