Modeling Incremental Benefit of Medication Reconciliation on ICU Outcomes

Abstract

Background: Medication errors such as medication discrepancies can occur in patients who are hospitalized and may result in adverse drug events (ADEs). Pharmacist-led medication reconciliation (MR) is an intervention that can be used to address medication discrepancies. Estimating the impact of MR in a medical setting is challenging to do experimentally. In this study, researchers implemented a mathematical model for estimating impact.

Methods: The authors modeled the effects of a series of incremental changes in MR completion on ADEs and conducted a cost-effectiveness analysis using a Markov chain model.

Results: In a 28-bed ICU, increasing the MR completion rate resulted in decreases in the total number of yearly ADEs by as many as 106, varying by the baseline ADE rate. The financial implications of increasing MR completion ranged from $27,808 in additional costs to $1,818,440 in savings on a yearly basis, depending on the baseline ADE rate and cost per ADE.

Conclusion: For institutions with low ADE rates, as MR completion increases and ADEs decrease, MR (though clinically beneficial) may not be financially worthwhile. However, MR implementation was found to produce significant savings for hospitals with average or high ADE rates.