The effectiveness of medication reconciliation strategies to reduce medication errors in community dwelling older adults: a systematic review

Field: Health Professions (Health Sciences)

Background Medication errors have been identified as a problem in health care that results in adverse drug events. It has been identified as a failure of an intended plan of action or the initiation of a wrong plan of action. Medication errors are pervasive in community dwelling older adults. Strategies that facilitate the prevention of medication errors warrant consideration. Medication reconciliation has been identified as one such a strategy. Objectives The objective of this systematic review was to identify, appraise and synthesize the best available evidence to determine the effectiveness of medication reconciliation strategies on medication errors among community dwelling older adults. Inclusion criteria Types of participants This review included older adults of all races and ethnicities (65 years of age and older) living in the community. Older adults with dementia or who were dependent on family or other individuals for care were not included. Types of intervention(s) This review considered studies that evaluated the effects of medication reconciliation strategies on medication errors in community dwelling older adults. Types of studies This review considered randomized controlled trials, non-randomized controlled trials and quasi-experimental studies. In the absence of the above, other study designs including case control, cross-sectional cohort, and before and after studies were considered. Types of outcomes This review considered the primary outcome measure of the number of medication errors. Medication errors may include but are not limited to: prescribing, labeling, dispensing, medication administration and medication reconstitution. Search strategy This search examined published and unpublished studies from the inception of databases to the present that were in English. Databases included: MEDLINE, CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Academic Search Premier, PsycINFO, Healthsource Nursing/Academic edition, and PubMed. Gray literature included Science.gov, scricus.com, Robert Wood Johnson Institute, and Dissertations Abstract International. Searches were completed in November 2012. Methodological quality Two independent reviewers evaluated the included studies for methodological quality using the standardized critical appraisal instruments from the Joanna Briggs Institute. Disagreements between the reviewers were resolved with a third reviewer. Data collection Data were extracted using the standardized data extraction tool from the Joanna Briggs Institute. Data synthesis Statistical pooling was not possible due to heterogeneity of the studies; therefore findings were presented as a narrative. Results This review yielded two level one randomized controlled trials and one level three prospective randomized comparative study. Studies presented evidence as to the potential positive outcomes of a pharmacist-led medication reconciliation on medication errors for community dwelling older adults. The way in which the pharmacist conducted the medication reconciliation varied across studies. Conclusions Medication reconciliation is complex and may be implemented in a variety of ways. For older adults residing in community settings, pharmacist-led medication reconciliation may possibly play a role in the reduction of medication errors. Implications for practice The ability to remain autonomous in the community depends on the older adult's ability to manage medications. This review suggests that pharmacist-led medication reconciliation may be integral to supporting this autonomy, and in preventing and decreasing medication errors. Implications for research Further research is necessary to determine the effectiveness of pharmacist-led medication reconciliation strategies in community dwelling older adults.