Inpatient Medication Reconciliations: Are They Complete and Equitable?

From the 2023 HVPA National Conference

Emma He BA (University of Chicago Pritzker School of Medicine), Alexandra Diaz-Barbe BA, Misha Tran MD, MS, Matthew Cerasale MD, MPH

Background:
Medication reconciliation is an essential part of hospital care. Failure to generate a correct list of medications on admission can cause patient harm both during hospitalization and after discharge. However, the accuracy and completeness of medication reconciliation efforts at our institution are not known. In addition, variations in these practices may occur based on admitting service, time of day, and patient factors. If areas of variation can be identified, resources to support medication reconciliation can be better allocated, enhancing the value, quality, and equitability of care.

Objectives:
To evaluate the timeliness and completeness of medication reconciliations. To identify any potential inequities in care

Methods:
This study was completed at a large, academic, urban, tertiary care hospital with a Level 1 trauma center. Medication reconciliations were reviewed from December 31, 2022, through February 19, 2023, via a data pull from the electronic health record (EHR). Information on patient demographics, admitting service and dates of admission were available through the data pull. Analyses were done to compare details of encounters where all medications were reconciled with visits where medication reconciliation was incomplete. These analyses were completed at 24 hours after admission and at discharge.

Results:
There were 3115 hospital visits at this tertiary care hospital during the study period. Medication reconciliations were completed within 24 hours for 2134 patients (68.5%) and for an additional 39 patients (1.2%) prior to discharge. Completion rates were similar between patients of different genders (70.0% men vs. 67.2% women), races (69.4% black vs. 67.1% all other races) and ages (69.3% >65 years vs. 67.9% <65 years). Weekdays and weekends had similar rates of completion (68.7% vs. 69.3%), as did night compared to day (69.9% vs. 67.6%). Language showed a non-significant trend towards high completion in non-English speaking patients (74.0% vs. 68.2%). Of patients with known places of origin, there was no difference between those who came from a healthcare setting and those who came from a non-healthcare setting (66.6% vs. 64.5%).

Conclusion:
Nearly one third of patients who were admitted had incomplete medication reconciliations based on listed home medications. In our analysis, no patient or hospital factors reviewed were associated with a significant difference in completion. Additional resources for medication reconciliation should be considered for patients with incomplete reconciliations on admission, as it is unlikely that it will be completed later in the encounter.

Clinical Implications:
A substantial proportion (30.3%) of admitted patients did not have complete medication reconciliations during their admissions. This suggests that a large proportion of patients could be at risk of iatrogenic harm due to medication discrepancies. New interventions to improve medication reconciliation are needed to improve quality of care and reduce risk of harm.

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