Effect of an electronic medication reconciliation application and process redesign on potential adverse drug events: a cluster-randomized trial.
BACKGROUND
Medication reconciliation at transitions in care is a national patient safety goal, but its effects on important patient outcomes require further evaluation. We sought to measure the impact of an information technology-based medication reconciliation intervention on medication discrepancies with potential for harm (potential adverse drug events [PADEs]).


METHODS
We performed a controlled trial, randomized by medical team, on general medical inpatient units at 2 academic hospitals from May to June 2006. We enrolled 322 patients admitted to 14 medical teams, for whom a medication history could be obtained before discharge. The intervention was a computerized medication reconciliation tool and process redesign involving physicians, nurses, and pharmacists. The main outcome was unintentional discrepancies between preadmission medications and admission or discharge medications that had potential for harm (PADEs).


RESULTS
Among 160 control patients, there were 230 PADEs (1.44 per patient), while among 162 intervention patients there were 170 PADEs (1.05 per patient) (adjusted relative risk [ARR], 0.72; 95% confidence interval [CI], 0.52-0.99). A significant benefit was found at hospital 1 (ARR, 0.60; 95% CI, 0.38-0.97) but not at hospital 2 (ARR, 0.87; 95% CI, 0.57-1.32) (P = .32 for test of effect modification). Hospitals differed in the extent of integration of the medication reconciliation tool into computerized provider order entry applications at discharge.


CONCLUSIONS
A computerized medication reconciliation tool and process redesign were associated with a decrease in unintentional medication discrepancies with potential for patient harm. Software integration issues are likely important for successful implementation of computerized medication reconciliation tools.
Schnipper
Jeffrey L
JL
Harvard Medical School, Division of General Medicine, Brigham and Women's Hospital, 1620 Tremont St, Boston, MA 02120-1613, USA. jschnipper@partners.org
Hamann
Claus
C
Ndumele
Chima D
CD
Liang
Catherine L
CL
Carty
Marcy G
MG
Karson
Andrew S
AS
Bhan
Ishir
I
Coley
Christopher M
CM
Poon
Eric
E
Turchin
Alexander
A
Labonville
Stephanie A
SA
Diedrichsen
Ellen K
EK
Lipsitz
Stuart
S
Broverman
Carol A
CA
McCarthy
Patricia
P
Gandhi
Tejal K
TK
D000368:Aged; D000369:Aged, 80 and over; D016303:Clinical Pharmacy Information Systems; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D008875:Middle Aged; D017064:Process Assessment, Health Care; D011785:Quality Assurance, Health Care / Q000379:methods