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A Cluster-Randomized Trial

Jeffrey L. Schnipper, MD, MPH; Claus Hamann, MD, MS; Chima D. Ndumele, MPH; Catherine L. Liang, MPH; Marcy G. Carty, MD, MPH; Andrew S. Karson, MD, MPH; Ishir Bhan, MD; Christopher M. Coley, MD; Eric Poon, MD, MPH; Alexander Turchin, MD, MS; Stephanie A. Labonville, PharmD, BCPS; Ellen K. Diedrichsen, PharmD; Stuart Lipsitz, ScD; Carol A. Broverman, PhD; Patricia McCarthy, PA, MHA; Tejal K. Gandhi, MD, MPH

Arch Intern Med. 2009;169(8):771-780.

Background  Medication reconciliation at transitions in care is a national patient safety goal, but its effects on important patient outcomes require further evaluation. We sought to measure the impact of an information technology–based medication reconciliation intervention on medication discrepancies with potential for harm (potential adverse drug events [PADEs]).

Methods  We performed a controlled trial, randomized by medical team, on general medical inpatient units at 2 academic hospitals from May to June 2006. We enrolled 322 patients admitted to 14 medical teams, for whom a medication history could be obtained before discharge. The intervention was a computerized medication reconciliation tool and process redesign involving physicians, nurses, and pharmacists. The main outcome was unintentional discrepancies between preadmission medications and admission or discharge medications that had potential for harm (PADEs).

Results  Among 160 control patients, there were 230 PADEs (1.44 per patient), while among 162 intervention patients there were 170 PADEs (1.05 per patient) (adjusted relative risk [ARR], 0.72; 95% confidence interval [CI], 0.52-0.99). A significant benefit was found at hospital 1 (ARR, 0.60; 95% CI, 0.38-0.97) but not at hospital 2 (ARR, 0.87; 95% CI, 0.57-1.32) (P = .32 for test of effect modification). Hospitals differed in the extent of integration of the medication reconciliation tool into computerized provider order entry applications at discharge.

Conclusions  A computerized medication reconciliation tool and process redesign were associated with a decrease in unintentional medication discrepancies with potential for patient harm. Software integration issues are likely important for successful implementation of computerized medication reconciliation tools.

Trial Registration  clinicaltrials.gov Identifier: NCT00296426

Author Affiliations: Brigham and Women's Academic Hospitalist Service (Drs Schnipper and Carty), Division of General Medicine (Drs Schnipper, Carty, Poon, Lipsitz, and Gandhi and Mr Ndumele and Ms Liang), Center for Clinical Excellence (Drs Carty and Gandhi), and Pharmacy Services (Dr Labonville), Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine (Dr Hamann, Karson, Bhan, and Coley), Geriatric Medicine Unit (Dr Hamann), Center for Quality and Safety (Dr Karson and Ms McCarthy), and Pharmacy Services (Dr Diedrichsen), Massachusetts General Hospital, Boston; Partners Information Systems Clinical Informatics Research and Development, Boston (Drs Poon, Turchin, and Broverman); and Harvard Medical School, Boston (Drs Schnipper, Hamann, Carty, Karson, Bhan, Coley, Poon, Turchin, Lipsitz, and Gandhi).

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