The Impact of Medication Reconciliation on Continuityof Drug Therapy during Perioperative Period

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Abstract

Background. Medication errors and resultant adverse drug events (ADEs) often occur during transitions of care. Up to 67% of in-patients’ prescriptions have at least one unintentional medication discrepancy with previously prescribed therapy. The proportion of clinically significant medication discrepancies is 11–59%. Studies from the developed countries demonstrated the effectiveness of medication reconciliation in reducing medication errors, ADEs and healthcare resource utilization. There is a necessity to conduct medication reconciliation studies within Russian current clinical practice to develop effective medical care quality and patients’ safety programs. Aims — to evaluate the impact of pharmacologist-led medication reconciliation on the frequency and structure of unintentional medication discrepancies and potential ADEs at hospital admission and discharge. Methods. Standard care was compared to medication reconciliation led by a clinical pharmacologist in a prospective randomized trial of 410 elective surgical patients. Medication discrepancies at hospital admission and discharge were identified and reconciled. Clinical outcomes were evaluated by reviewing electronic health records. Results. In the intervention group the frequency of unintentional discrepancies at hospital admission decreased from 32.68 to 16.86%, the proportion of patients with at least one unintentional discrepancy decreased from 64.9 to 44.9%, the number of discrepancies per patient decreased from 1.5 to 0.66. The incidence of discrepancies at hospital discharge decreased from 82.90 to 43.29%, the proportion of patients with discrepancies decreased from 95.61 to 52.68%, the average number of discrepancies per patient decreased from 2.79 to 1.67. Medication reconciliation led by clinical pharmacologist decreased the frequency of unscheduled out-patient visits after discharge from 7.32 to 2.93%. The determined risk factors for unintentional discrepancies at hospital admission were: prescribing of cardiovascular, endocrine drugs and those affecting the central nervous system. Both at admission and discharge medication reconciliation was the significant factor reducing the risk of unintentional discrepancies. Conclusions. Medication reconciliation at hospital admission and discharge reduces the frequency of unintentional discrepancies in drug prescriptions by 16 and 40%, respectively. The implementation of medication reconciliation into clinical practice reduces unscheduled out-patient visits after hospital discharge.

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About the authors

Maria D. Nigmatkulova

Russian Medical Academy of Continuing Professional Education; General Medical Center of the Bank of Russia

Email: mnigmatkulova@gmail.com
ORCID iD: 0000-0001-8840-4904
SPIN-code: 2263-3980

graduate student, clinical pharmacologist

Russian Federation, 66, Sevastopolskij ave., Moscow, 117647; 2/1, Barrikadnaya st., Moscow, 125993

E. B. Kleymenova

General Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional Education; Federal Research Center «Computer Science and Control» of the Russian Academy of Sciences

Email: e.kleymenova@gmail.com
ORCID iD: 0000-0002-8745-6195
SPIN-code: 2037-7164

MD, PhD

Russian Federation, 66, Sevastopolskii ave., Moscow, 117647; 2/1, Barrikadnaya st., Moscow, 125993; 44-2, Vavilova str., Moscow, 119333

Liubov P. Yashina

General Medical Center of the Bank of Russia; Federal Research Center «Computer Science and Control» of the Russian Academy of Sciences

Email: lyashina1@yandex.ru
ORCID iD: 0000-0003-1357-0056
SPIN-code: 1910-0484

PhD in Biology

Russian Federation, 66, Sevastopolskii ave., Moscow, 117647; 125993; 44-2, Vavilova str., Moscow, 119333

Dmitry A. Sychev

Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation

Author for correspondence.
Email: dimasychev@mail.ru
ORCID iD: 0000-0002-4496-3680
SPIN-code: 4525-7556

MD, PhD, Professor, Corresponding Member of the RAS

Russian Federation, 2/1, Barrikadnaya st., Moscow, 125993

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