title: Using novel Canadian resources to improve medication reconciliation at discharge: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Adverse drug events are responsible for up to 7% of all admissions to acute care hospitals. At least 58% of these are preventable, resulting from incomplete drug information, prescribing or dispensing errors, and overuse or underuse of medications. Effective implementation of medication reconciliation is considered essential to reduce preventable adverse drug events occurring at transitions between community and hospital care. An electronically enabled discharge reconciliation process represents an innovative approach to this problem.
  
  
  METHODS
  Participants will be recruited in Quebec and are eligible for inclusion if they are using prescription medication at admission, covered by the Quebec drug insurance plan, admitted from the community, 18 years or older, admitted to a general or intensive care medical or surgical unit, and discharged alive. A sample size of 3,714 will be required to detect a 5% reduction in adverse drug events. The intervention will comprise electronic retrieval of the community drug list, combined with an electronic discharge reconciliation module and an electronic discharge communication module. The primary outcomes will be adverse drug events occurring 30 days post-discharge, identified by a combination of patient self-report and chart abstraction. All emergency room visits and hospital readmission during this period will be measured as secondary outcomes. A cluster randomization approach will be used to allocate 16 medical and 10 surgical units to electronic discharge reconciliation and communication versus usual care. An intention-to-treat approach will be used to analyse data. Logistic regression will be undertaken within a generalized estimating equation framework to account for clustering within units.
  
  
  CONCLUSIONS
  The goal of this prospective trial is to determine if electronically enabled discharge reconciliation will reduce the risk of adverse drug events, emergency room visits and readmissions 30 days post-discharge compared with usual care. We expect that this intervention will improve adherence to medication reconciliation at discharge, the accuracy of the community-based drug history and effective communication of hospital-based treatment changes to community care providers. The results may support policy-directed investments in computerizing and training of hospital staff, generate key requirements for future hospital accreditation standards, and highlight functional requirements for software vendors.
  
  
  BACKGROUND
  NCT01179867.
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC H3A 1A2, Canada. robyn.tamblyn@mcgill.ca
authors.forename: Robyn
authors.initials: R
authors.lastname: Tamblyn
authors.forename: Allen R
authors.initials: AR
authors.lastname: Huang
authors.forename: Ari N
authors.initials: AN
authors.lastname: Meguerditchian
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Winslade
authors.forename: Christian
authors.initials: C
authors.lastname: Rochefort
authors.forename: Alan
authors.initials: A
authors.lastname: Forster
authors.forename: Tewodros
authors.initials: T
authors.lastname: Eguale
authors.forename: David
authors.initials: D
authors.lastname: Buckeridge
authors.forename: André
authors.initials: A
authors.lastname: Jacques
authors.forename: Kiyuri
authors.initials: K
authors.lastname: Naicker
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Reidel
mesh_terms: D016303:Clinical Pharmacy Information Systems; D016000:Cluster Analysis; D003142:Communication; D003157:Community Pharmacy Services; D003266:Continuity of Patient Care; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D057286:Electronic Health Records; D004636:Emergency Service, Hospital; D006801:Humans; D016015:Logistic Models; D008498:Medical Record Linkage; D059065:Medication Reconciliation; D010351:Patient Discharge; D010359:Patient Readmission; D010607:Pharmacy Service, Hospital; D011446:Prospective Studies; D011792:Quebec; D012107:Research Design; D012307:Risk Factors; D013997:Time Factors