title: Pharmacist-led admission medication reconciliation before and after the implementation of an electronic medication management system.
abstract: To investigate the impact of the introduction of an electronic medication management system on the proportion of patients with a recorded medication reconciliation on admission, the time from admission to when medication reconciliation was performed, and the characteristics of patients receiving this intervention pre-and post-implementation.
  
  
  
  An electronic medication management system was implemented in an Australian hospital from May to July 2015. A retrospective observational study was conducted in three wards across two phases; pre- (August 2014) and post- (August 2015) implementation. The study sample included every second patient admitted to these wards.
  
  
  
  A total of 370 patients were included, 179 pre- and 191 post-implementation. The proportion of recorded admission medication reconciliation significantly increased post-implementation in all study wards; coronary care unit (40 vs 68%, p=0.004), gastroenterology ward (39 vs 59%, p=0.015), and the neurology ward (19 vs 45%, p=0.002). The proportion of patients with recorded medication reconciliation within 24h of weekday admissions, or 48-72h of weekend admissions, increased from 47% pre- to 84% post-implementation. Admission medication reconciliation was recorded within a median of 1.0day for weekday admissions pre- and post-implementation (IQR 1.1 vs 0.2, respectively), and 3.5days (IQR 2.0) pre-implementation vs 1.5days (IQR 2.0) post-implementation for weekend admissions. Overall, across both phases pre-and post-implementation, admission medication reconciliation was recorded for patients who were significantly older (median 77 and 71 years, p<0.001), had a higher number of preadmission medications (median 6.5 and 5.0 medicines, p=0.001), and had a longer hospital stay (median 6.5 and 5.1days, p=0.003). A significantly higher proportion of patients with recorded medication reconciliation in the pre-implementation phase experienced polypharmacy (61%, p=0.002), hyperpolypharmacy (15%, p=0.001), and used a high-risk medication (44%, p=0.007).
  
  
  
  Implementing an electronic medication management system facilitates the medication reconciliation process leading to more high risk patients receiving this service on admission to hospital and in a more timely manner. The impact of electronic medication reconciliation on patient safety and clinical outcomes remains unknown.
authors.affiliation: Faculty of Pharmacy, University of Sydney, Sydney, Australia. Electronic address: Aabu6548@uni.sydney.edu.au.
authors.forename: Arwa A
authors.initials: AA
authors.lastname: Sardaneh
authors.affiliation: Pharmacy Department, Concord Repatriation General Hospital, Concord, Australia; Clinical Lead, Electronic Medication Management, Concord Repatriation General Hospital, Concord, Australia.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Burke
authors.affiliation: Clinical Lead, Electronic Medication Management, Concord Repatriation General Hospital, Concord, Australia; Department of Renal Medicine, Concord Repatriation General Hospital, Concord, Australia.
authors.forename: Angus
authors.initials: A
authors.lastname: Ritchie
authors.affiliation: Faculty of Pharmacy, University of Sydney, Sydney, Australia; Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Concord, Australia.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: McLachlan
authors.affiliation: Faculty of Pharmacy, University of Sydney, Sydney, Australia; Medical Management Centre, LIME, Karolinska Institute, Stockholm, Sweden. Electronic address: elin.c.lehnbom@uit.no.
authors.forename: Elin C
authors.initials: EC
authors.lastname: Lehnbom
mesh_terms: D000368:Aged; D001315:Australia; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D059065:Medication Reconciliation / Q000379:methods*; D010343:Patient Admission; D061214:Patient Safety; D010595:Pharmacists / Q000458:organization & administration*; D012189:Retrospective Studies
keywords: Admission; Electronic medication management system; Medication reconciliation; Patient risk assessment