Impact of electronic medication reconciliation interventions on medication discrepancies at hospital transitions: a systematic review and meta-analysis

Abstract

Background: Medication reconciliation has been identified as an important intervention to minimize the incidence of unintentional medication discrepancies at transitions in care. However, there is a lack of evidence for the impact of information technology on the rate and incidence of medication discrepancies identified during care transitions. This systematic review was thus, aimed to evaluate the impact of electronic medication reconciliation interventions on the occurrence of medication discrepancies at hospital transitions.

Methods: Systematic literature searches were performed in MEDLINE, PubMed, CINHAL, and EMBASE from inception to November, 2015. We included published studies in English that evaluated the effect of information technology on the incidence and rate of medication discrepancies compared with usual care. Cochrane's tools were used for assessment of the quality of included studies. We performed meta-analyses using random-effects models.

Results: Ten studies met our inclusion criteria; of which only one was a randomized controlled trial. Interventions were carried out at various hospital transitions (admission, 5; discharge, 2 and multiple transitions, 3 studies). Meta-analysis showed a significant reduction of 45 % in the proportion of medications with unintentional discrepancies after the use of electronic medication reconciliation (RR 0.55; 95 % CI 0.51 to 0.58). However, there was no significant reduction in either the proportion of patients with medication discrepancies or the mean number of discrepancies per patient. Drug omissions were the most common types of unintended discrepancies, and with an electronic tool a significant but heterogeneously distributed reduction of omission errors over the total number of medications reconciled have been observed (RR 0.20; 95 % CI 0.06 to 0.66). The clinical impact of unintended discrepancies was evaluated in five studies, and there was no potentially fatal error identified and most errors were minor in severity.

Conclusion: Medication reconciliation supported by an electronic tool was able to minimize the incidence of medications with unintended discrepancy, mainly drug omissions. But, this did not consistently reduce other process outcomes, although there was a lack of rigorous design to conform these results.

Keywords: Care transition; Electronic medication reconciliation; Medication discrepancies; Medication errors; Medication history; Medication safety.

Fig. 1

PRISMA flow diagram of included studies

Fig. 2

Meta-analysis of the effectiveness of electronic medication reconciliation on the proportion of patients with medication discrepancies at hospital transitions

Fig. 3

Meta-analysis of the effectiveness of electronic medication reconciliation on the incidence of medications with unintentional discrepancies over the total number of medications reconciled at hospital transitions

Fig. 4

Meta-analysis of the effectiveness of electronic medication reconciliation on unintentional medication discrepancies expressed in terms of the mean number of medication discrepancies per patient

Fig. 5

Meta-analysis of the effectiveness of electronic medication reconciliation on the percentage of omission errors over the total number of medications reconciled