Differences in medication reconciliation interventions between six hospitals: a mixed method study

Background Although medication reconciliation (MedRec) is mandated and effective in decreasing preventable medication errors during transition of care, hospitals implement MedRec differently. Objective Quantitatively compare the number and type of MedRec interventions between hospitals upon admission and discharge, followed by a qualitative analysis on potential reasons for these differences. Methods This explanatory retrospective mixed method study consisted of a quantitative and a qualitative part. Patients from six hospitals and various wards were included if MedRec was performed both on hospital admission and discharge. Information on pharmacy interventions to resolve unintended discrepancies and medication optimizations were collected. Based on these quantitative results, interviews and a focus group was performed to give insight in MedRec processes. Descriptive analysis was used for the quantitative-, content analysis for the qualitative part. Results On admission, patients with at least one discrepancy varied from 36-95% (mean per patient 2.2 (SD +/- 2.4) Upon discharge, these numbers ranged from 5-28% while optimizations reached 2% (admission) to 95% (discharge).The main themes explaining differences in numbers of interventions were patient-mix, healthcare professionals involved, location and moment of the interview plus embedding and extent of medication optimization. Conclusions Hospitals differed greatly in the number of interventions performed during MedRec. A combination of patient-mix, healthcare professionals involved, location and timing of the interview plus embedding and extent of medication optimization resulted in the highest yield of MedRec interventions on unintended medication discrepancies and optimizations. This study supports to give direction to optimize MedRec processes in hospitals.