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Predictors for unintentional medication reconciliation discrepancies in preadmission medication: a systematic review

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Abstract

Purpose

Discrepancies in preadmission medication (PAM) are common and potentially harmful. Medication reconciliation is able to reduce the discrepancy rate, yet implementation is challenging. In order for reconciliation efforts to be more cost-effective, patients at high risk for reconciliation errors should be identified. The purpose of this systematic review is to identify predictors for unintentional discrepancies in PAM.

Methods

Medline and Embase were searched systematically until June 2017. Only studies concerning adult subjects were retained. Quantitative studies were included if predictors for unintentional discrepancies in the PAM had been determined on hospital admission. Variables were divided into patient-, medication-, and setting-related predictors based on a thematic analysis. Studies on identification of predictors for discrepancies and potentially harmful discrepancies were handled separately.

Results

Thirty-five studies were eligible, of which 5 studies focused on potentially harmful discrepancies. The following 16 significant variables were identified using multivariable prediction models: number of preadmission drugs, patient’s age, availability of a drug list, patients’ understanding of medication, usage of different outpatient pharmacies, number of high-risk drugs, discipline for which the patient is admitted, admitting physician’s experience, number and type of consulted sources, patient’s gender, type of care before admission, number of outpatient visits during the past year, class of medication, number of reimbursements, use of an electronic prescription system, and type of admission (elective vs emergency). The number of preadmission drugs was identified as a predictor in 20 studies. Potentially harmful discrepancies were ascertained in 5 studies with age found to have a predictive value in all 5 studies.

Conclusion

Multiple suitable predictors for PAM-related discrepancies were identified of which higher age and polypharmacy were reported most frequently.

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References

  1. Mueller SK, Sponsler KC, Kripalani S, Schnipper JL (2012) Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med 172(14):1057–1069. doi:10.1001/archinternmed.2012.2246

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kwan JL, Lo L, Sampson M, Shojania KG (2013) Medication reconciliation during transitions of care as a patient safety strategy: a systematic review. Ann Intern Med 158(5 Pt 2):397–403. doi:10.7326/0003-4819-158-5-201303051-00006

    Article  PubMed  Google Scholar 

  3. Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R, Etchells EE (2005) Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. Can Med Assoc J 173(5):510–515

    Article  Google Scholar 

  4. Lehnbom EC, Stewart MJ, Manias E, Westbrook JI (2014) Impact of medication reconciliation and review on clinical outcomes. In: Ann Pharmacothered. (c) The Author(s) 2014., pp 1298–1312

  5. Climente-Marti M, Garcia-Manon ER, Artero-Mora A, Jimenez-Torres NV (2010) Potential risk of medication discrepancies and reconciliation errors at admission and discharge from an inpatient medical service. Ann Pharmacother 44(11):1747–1754. doi:10.1345/aph.1P184

    Article  PubMed  Google Scholar 

  6. Cornu P, Steurbaut S, Leysen T, De Baere E, Ligneel C, Mets T, Dupont AG (2012) Effect of medication reconciliation at hospital admission on medication discrepancies during hospitalization and at discharge. Int J Clin Pharm 34(1):213–214. doi:10.1007/s11096-011-9602-2

    Google Scholar 

  7. Hellstrom LM, Bondesson A, Hoglund P, Eriksson T (2012) Errors in medication history at hospital admission: prevalence and predicting factors. BMC Clin Pharmacol 12:9. doi:10.1186/1472-6904-12-9

    Article  PubMed  PubMed Central  Google Scholar 

  8. Feldman LS, Costa LL, Feroli ER Jr, Nelson T, Poe SS, Frick KD, Efird LE, Miller RG (2012) Nurse-pharmacist collaboration on medication reconciliation prevents potential harm. J Hosp Med 7(5):396–401. doi:10.1002/jhm.1921

    Article  PubMed  Google Scholar 

  9. Quelennec B, Beretz L, Paya D, Blickle JF, Gourieux B, Andres E, Michel B (2013) Potential clinical impact of medication discrepancies at hospital admission. Eur J Intern Med 24(6):530–535. doi:10.1016/j.ejim.2013.02.007

    Article  PubMed  Google Scholar 

  10. Schnipper JL, Hamann C, Ndumele CD, Liang CL, Carty MG, Karson AS, Bhan I, Coley CM, Poon E, Turchin A, Labonville SA, Diedrichsen EK, Lipsitz S, Broverman CA, McCarthy P, Gandhi TK (2009) Effect of an electronic medication reconciliation application and process redesign on potential adverse drug events a cluster-randomized trial. Arch Intern Med 169(8):771–780

    Article  PubMed  Google Scholar 

  11. De Winter S, Vanbrabant P, Spriet I, Desruelles D, Indevuyst C, Knockaert D, Gillet JB, Willems L (2011) A simple tool to improve medication reconciliation at the emergency department. Eur J Intern Med 22(4):382–385. doi:10.1016/j.ejim.2011.03.010

    Article  PubMed  Google Scholar 

  12. Marinovic I, Marusic S, Mucalo I, Mesaric J, Bacic Vrca V (2016) Clinical pharmacist-led program on medication reconciliation implementation at hospital admission: experience of a single university hospital in Croatia. Croat Med J 57(6):572–581

    Article  PubMed  PubMed Central  Google Scholar 

  13. Saint-Germain P, Ruelle M, Mary A, Sid Idris S, Hannat S, Pelloquin N, Jouanny P, Terrier-Lenglet A (2016) The clinical impact of treatment discrepancies recorded for 200 patients in an acute geriatric unit. Rev Med Interne 37(10):667–673. doi:10.1016/j.revmed.2016.02.017

    Article  CAS  PubMed  Google Scholar 

  14. Breuker C, Abraham O, di Trapanie L, Mura T, Macioce V, Boegner C, Jalabert A, Villiet M, Castet-Nicolas A, Avignon A, Sultan A (2017) Patients with diabetes are at high risk of serious medication errors at hospital: interest of clinical pharmacist intervention to improve healthcare. Eur J Intern Med 38:38–45. doi:10.1016/j.ejim.2016.12.003

    Article  PubMed  Google Scholar 

  15. Mendes AE, Lombardi NF, Andrzejevski VS, Frandoloso G, Correr CJ, Carvalho M (2016) Medication reconciliation at patient admission: a randomized controlled trial. Pharm Pract 14 (1) DOI: 10.18549/PharmPract.2016.01.656

  16. Greenwald JL, Halasyamani L, Greene J, LaCivita C, Stucky E, Benjamin B, Reid W, Griffin FA, Vaida AJ, Williams MV (2010) Making inpatient medication reconciliation patient centered, clinically relevant and implementable: a consensus statement on key principles and necessary first steps. J Hosp Med 5(8):477–485. doi:10.1002/jhm.849

    Article  PubMed  Google Scholar 

  17. Grimes T, Fitzsimons M, Galvin M, Delaney T (2013) Relative accuracy and availability of an irish national database of dispensed medication as a source of medication history information: observational study and retrospective record analysis. J Clin Pharm Ther 38(3):219–224

    Article  CAS  PubMed  Google Scholar 

  18. Zoni AC, Duran Garcia ME, Jimenez Munoz AB, Salomon Perez R, Martin P, Herranz Alonso A (2012) The impact of medication reconciliation program at admission in an internal medicine department. Eur J Intern Med 23(8):696–700. doi:10.1016/j.ejim.2012.08.013

    Article  PubMed  Google Scholar 

  19. Sponsler KC, Neal EB, Kripalani S (2015) Improving medication safety during hospital-based transitions of care. Cleve Clin J Med 82(6):351–360. doi:10.3949/ccjm.82a.14025

    Article  PubMed  Google Scholar 

  20. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4):264–269 W264

    Article  PubMed  Google Scholar 

  21. Wells GA SB, O’Connell D, Peterson J, Welch V, Losos M ([cited31may2014]) The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. Available from: URL:http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp In: ed

  22. http://handbook.cochrane.org/ cited: 15 march 2015. In: ed

  23. Oremus M HA, Raina P. (2011) Health risk appraisal [Internet]. Agency for Healthcare Research and Quality, (US)

  24. Tamblyn R, Poissant L, Huang A, Winslade N, Rochefort CM, Moraga T, Doran P (2014) Estimating the information gap between emergency department records of community medication compared to on-line access to the community-based pharmacy records. J Am Med Inform Assoc 21(3):391–398. doi:10.1136/amiajnl-2013-001704

    Article  PubMed  Google Scholar 

  25. Glintborg B, Poulsen HE, Dalhoff KP (2008) The use of nationwide on-line prescription records improves the drug history in hospitalized patients. Br J Clin Pharmacol 65(2):265–269. doi:10.1111/j.1365-2125.2007.03017.x

    Article  PubMed  Google Scholar 

  26. Unroe KT, Pfeiffenberger T, Pharm SR, Jastrzembski J, Lokhnygina Y, Colon-Emeric C (2010) Inpatient medication reconciliation at admission and discharge: a retrospective cohort study of age and other risk factors for medication discrepancies. Am J Geriatr Pharmacother 8(2):115–126

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gleason KM, McDaniel MR, Feinglass J, Baker DW, Lindquist L, Liss D, Noskin GA (2010) Results of the Medications at Transitions and Clinical Handoffs (MATCH) study: an analysis of medication reconciliation errors and risk factors at hospital admission. J Gen Intern Med 25(5):441–447. doi:10.1007/s11606-010-1256-6

    Article  PubMed  PubMed Central  Google Scholar 

  28. Hatch J, Becker T, Fish J (2011) Difference between pharmacist-obtained and physician-obtained medication histories in the intensive care unit. Hosp Pharm 46(4):262–268

    Article  Google Scholar 

  29. Pippins JR, Gandhi TK, Hamann C, Ndumele CD, Labonville SA, Diedrichsen EK, Carty MG, Karson AS, Bhan I, Coley CM, Liang CL, Turchin A, McCarthy PC, Schnipper JL (2008) Classifying and predicting errors of inpatient medication reconciliation. J Gen Intern Med 23(9):1414–1422. doi:10.1007/s11606-008-0687-9

    Article  PubMed  PubMed Central  Google Scholar 

  30. Damlien L, Davidsen N, Nilsen M, Godo A, Moger TA, Viktil KK (2015) Drug safety at admission to emergency department: an innovative model for PRIOritizing patients for MEdication Reconciliation (PRIOMER). Eur J Emerg Med. doi:10.1097/mej.0000000000000355

  31. De Winter S, Vanbrabant P, Laeremans P, Foulon V, Willems L, Verelst S, Spriet I (2017) Developing a decision rule to optimise clinical pharmacist resources for medication reconciliation in the emergency department. Emerg Med J. doi:10.1136/emermed-2016-205804

  32. Baena Parejo MI, Borrego AMJ, Ruiz JA, Monjó MC, García-Peláez M, Hernanz BC, Hernández MAC, Fernández MIC, Riera MP, Sánchez RG, Sánchez LG, López CV, Echeverria MDM, Serrano PM (2015) Medication list assessment in Spanish hospital emergency departments. J Emerg Med 48(4):416–423. doi:10.1016/j.jemermed.2014.06.063

    Article  PubMed  Google Scholar 

  33. Lubowski TJ, Cronin LM, Pavelka RW, Briscoe-Dwyer LA, Briceland LL, Hamilton RA (2007) Effectiveness of a medication reconciliation project conducted by PharmD students. Am J Pharm Educ 71(5):94

    Article  PubMed  PubMed Central  Google Scholar 

  34. Chan AH, Garratt E, Lawrence B, Turnbull N, Pratapsingh P, Black PN (2010) Effect of education on the recording of medicines on admission to hospital. J Gen Intern Med 25(6):537–542. doi:10.1007/s11606-010-1317-x

    Article  PubMed  PubMed Central  Google Scholar 

  35. Salanitro AH, Osborn CY, Schnipper JL, Roumie CL, Labonville S, Johnson DC, Neal E, Cawthon C, Businger A, Dalal AK, Kripalani S (2012) Effect of patient- and medication-related factors on inpatient medication reconciliation errors. J Gen Intern Med 27(8):924–932. doi:10.1007/s11606-012-2003-y

    Article  PubMed  PubMed Central  Google Scholar 

  36. Schnipper JL, Roumie CL, Cawthon C, Businger A, Dalal AK, Mugalla I, Eden S, Jacobson TA, Rask KJ, Vaccarino V, Gandhi TK, Bates DW, Johnson DC, Labonville S, Gregory D, Kripalani S (2010) Rationale and design of the Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) study. Circ Cardiovasc Qual Outcomes 3(2):212–219. doi:10.1161/circoutcomes.109.921833

    Article  PubMed  PubMed Central  Google Scholar 

  37. Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, Laffel G, Sweitzer BJ, Shea BF, Hallisey R et al (1995) Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prev Study Group JAMA 274(1):29–34

    CAS  Google Scholar 

  38. Andersen SE, Pedersen AB, Bach KF (2003) Medication history on internal medicine wards: assessment of extra information collected from second drug interviews and GP lists. Pharmacoepidemiol Drug Saf 12(6):491–498

    Article  CAS  PubMed  Google Scholar 

  39. Balon J, Thomas SA (2011) Comparison of hospital admission medication lists with primary care physician and outpatient pharmacy lists. J Nurs Scholarsh 43(3):292–300

    PubMed  Google Scholar 

  40. Knez L, Suskovic S, Rezonja R, Laaksonen R, Mrhar A (2011) The need for medication reconciliation: a cross-sectional observational study in adult patients. Respir Med 105(SUPPL. 1):S60–S66

    Article  PubMed  Google Scholar 

  41. Cornish PL, Knowles SR, Marchesano R, Tam V, Shadowitz S, Juurlink DN, Etchells EE (2005) Unintended medication discrepancies at the time of hospital admission. Arch Intern Med 165(4):424–429

    Article  PubMed  Google Scholar 

  42. Rodriguez Vargas B, Delgado Silveira E, Montero Errasquin B, Bermejo Vicedo T (2013) Conciliation of the pharmacological treatment of patients older than 65 years at hospital admission. Atencion Farmaceutica 15(1):35–39

    Google Scholar 

  43. Beers MH, Munekata M, Storrie M (1990) The accuracy of medication histories in the hospital medical records of elderly persons. J Am Geriatr Soc 38(11):1183–1187

    Article  CAS  PubMed  Google Scholar 

  44. Steurbaut S, Leemans L, Leysen T, De Baere E, Cornu P, Mets T, Dupont AG (2010) Medication history reconciliation by clinical pharmacists in elderly inpatients admitted from home or a nursing home. Ann Pharmacother 44(10):1596–1603. doi:10.1345/aph.1P192

    Article  PubMed  Google Scholar 

  45. Belda-Rustarazo S, Cantero-Hinojosa J, Salmeron-García A, González-García L, Cabeza-Barrera J, Galvez J (2015) Medication reconciliation at admission and discharge: an analysis of prevalence and associated risk factors. Int J Clin Pract 69(11):1268–1274. doi:10.1111/ijcp.12701

    Article  CAS  PubMed  Google Scholar 

  46. González-García L, Salmerón-García A, García-Lirola M, Moya-Roldán S, Belda-Rustarazo S, Cabeza-Barrera J (2016) Medication reconciliation at admission to surgical departments. J Eval Clin Pract 22(1):20–25. doi:10.1111/jep.12403

    Article  PubMed  Google Scholar 

  47. Pascual O, Real JM, Uriarte M, Larrodé I, Alonso YM, Abad MR (2015) Evaluation of medication reconcilliation in a trauma unit. Rev Esp Cir Ortop Traumatol 59(2):91–96. doi:10.1016/j.recot.2014.07.003

    CAS  PubMed  Google Scholar 

  48. Rodriguez Vargas B, Delgado Silveira E, Iglesias Peinado I, Bermejo Vicedo T (2016) Prevalence and risk factors for medication reconciliation errors during hospital admission in elderly patients. Int J Clin Pharm 38(5):1164–1171. doi:10.1007/s11096-016-0348-8

    Article  PubMed  Google Scholar 

  49. Perehudoff K, Azermai M, Somers A, Vander Stichele R, Petrovic M (2015) Medication discrepancies in older patients admitted to non-geriatric wards: an exploratory study. Eur Geriatr Med 6(1):41–45. doi:10.1016/j.eurger.2014.10.005

    Article  Google Scholar 

  50. Spalla LR, Castilho SR (2016) Medication reconciliation as a strategy for preventing medication errors. Braz J Pharm Sci 52(1):143–150. doi:10.1590/S1984-82502016000100016

    Article  Google Scholar 

  51. Nilsson N, Lea M, Lao Y, Wendelbo K, Gløersen G, Mowé M, Blix HS, Viktil KK (2015) Medication discrepancies revealed by medication reconciliation and their potential short-term and long-term effects: a Norwegian multicentre study carried out on internal medicine wards. Eur J Hosp Pharm 22(5):298–303. doi:10.1136/ejhpharm-2015-000686

    Article  Google Scholar 

  52. Wuerz RC, Milne LW, Eitel DR, Travers D, Gilboy N (2000) Reliability and validity of a new five-level triage instrument. Acad Emerg Med 7(3):236–242

    Article  CAS  PubMed  Google Scholar 

  53. Salanitro AH, Kripalani S, Resnic J, Mueller SK, Wetterneck TB, Haynes KT, Stein J, Kaboli PJ, Labonville S, Etchells E, Cobaugh DJ, Hanson D, Greenwald JL, Williams MV, Schnipper JL (2013) Rationale and design of the Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS). BMC Health Serv Res 13:230

    Article  PubMed  PubMed Central  Google Scholar 

  54. (Cited: 28 June 2015 ) Marquis implementation manual. A guide for medication reconciliation quality improvement. September, 2011. Available from URL: http://tools.hospitalmedicine.org/resource_rooms/imp_guides/MARQUIS/marquis.html In: ed

  55. Engqvist I, Wyss K, Asker-Hagelberg C, Bergman U, Odar-Cederlöf I, Stiller CO, Fryckstedt J (2015) Which medication is the patient taking at admission to the emergency ward? Still unclear despite the Swedish prescribed drug register. PLoS One 10(6). doi:10.1371/journal.pone.0128716

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Acknowledgements

We want to thank Marleen Michels, for peer-reviewing our search query.

Contributors

Julie Hias, Lorenz Van der Linden, and Sabrina De Winter participated in the study concept, retrieval of articles, data analysis, interpretation of data, and preparation of the manuscript. Isabel Spriet participated in the study concept, interpretation of data, and preparation of the manuscript. Jos Tournoy, Peter Vanbrabant, and Ludo Willems participated in the interpretation of data and preparation of the manuscript.

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Correspondence to Julie Hias.

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Julie Hias and Lorenz Van der Linden shared first author.

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Hias, J., Van der Linden, L., Spriet, I. et al. Predictors for unintentional medication reconciliation discrepancies in preadmission medication: a systematic review. Eur J Clin Pharmacol 73, 1355–1377 (2017). https://doi.org/10.1007/s00228-017-2308-1

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