Abstract
BackgroundMedication 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.MethodsSystematic 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.ResultsTen 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.ConclusionMedication 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0353-9) contains supplementary material, which is available to authorized users.
Highlights
Medication reconciliation has been identified as an important intervention to minimize the incidence of unintentional medication discrepancies at transitions in care
The main reasons for exclusion were either due to reporting of a different outcome of interest (n = 21) or medication reconciliation was not supported by information technology (n = 12) (Additional file 2)
There was no potentially fatal error identified, and most errors were minor in severity
Summary
Medication reconciliation has been identified as an important intervention to minimize the incidence of unintentional medication discrepancies at transitions in care. 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 aimed to evaluate the impact of electronic medication reconciliation interventions on the occurrence of medication discrepancies at hospital transitions. Medication reconciliation has been recognized as an important approach to improve the quality use of medicines by reducing the burden of medication discrepancies at care transitions [1,2,3,4]. Previous reviews [26, 27] included medication reconciliation interventions carried out by physicians, nurses, pharmacists and electronic medication reconciliation and evaluated both clinical (e.g. hospital readmissions) and process outcomes
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