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‘The Problem with…’ series covers controversial topics related to efforts to improve healthcare quality, including widely recommended but deceptively difficult strategies for improvement and pervasive problems that seem to resist solution.
Medication reconciliation: a brief summary of the evidence, and the problem with generalising that evidence
Medication reconciliation (‘med rec’, as it is often called) refers to the ‘process of identifying the most accurate list of all medications a patient is taking … and using this list to provide correct medications for patients anywhere within the health system’.1 Two recent systematic reviews summarised the evidence for med rec interventions, finding that several med rec interventions reduced medication history errors and errors in patients’ admission and discharge medication regimens.2 ,3 Despite documented efficacy in reducing errors, there are caveats. An earlier literature review showed that the clinical significance of medication history errors varies substantially—between 11% and 59%.4 Furthermore, although errors associated with harm were prevented in those studies that examined it,2 adverse drug events (ADEs) have been infrequently examined. Also, only a few studies have shown decreased healthcare usage,5 ,6 and to our knowledge none have shown direct cost savings.
Despite imperfect evidence, The US Joint Commission and Accreditation Canada initially mandated universal med rec in 2005.7 ,8 In addition to the subset of aforementioned evidence in existence at that time, these mandates were driven by frequent anecdotes of ADEs related to med rec errors and strong face-validity of preserving and communicating medication information across patient encounters. Unfortunately, although some organisations mobilised substantial resources to comply with these mandates, other organisations undoubtedly improved documentation of med rec (as per the mandate requirements) rather than actual medication safety.9 Although most studies of med rec interventions report positive results, at least one review found publication bias:2 many negative experiences associated with med rec interventions were never reported. …
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