Cochrane · systematic review · CD009985
Reducing medication errors for adults in hospital settings
Ciapponi, A, Fernandez Nievas, SE, Seijo, M, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
Effective Practice and Organisation of CareAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
37
current version
GRADE rated
37
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 11 · 29.7%Low 18 · 48.6%Moderate 8 · 21.6%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Medication reconciliation versus no medication reconciliation
Population: adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Medication errors ( Medication reconciliation vs no medication reconciliation | OR 0.55 [0.17, 1.74] | 3 studies · 379 participants | Low Downgraded: risk of bias, imprecision |
ADEs ( Medication reconciliation vs no medication reconciliation | OR 0.38 [0.18, 0.8] | 3 studies · 1336 participants | Moderate Downgraded: inconsistency |
Mortality during hospitalisation ( Medication reconciliation vs no medication reconciliation | RR 3.85 [0.44, 33.89] | 1 study · 212 participants | Very low Downgraded: risk of bias, inconsistency |
Length of stay (days) ( Medication reconciliation vs no medication reconciliation | no estimate extracted | 3 studies · 527 participants | Low Downgraded: risk of bias, imprecision |
Quality of life (VAS 0‐10; EQ‐5D‐3L) ( Medication reconciliation vs no medication reconciliation | no estimate extracted | 1 study · 131 participants | Low Downgraded: risk of bias, imprecision |
Discrepancy resolution ( Medication reconciliation vs no medication reconciliation | RR 7.48 [5.62, 9.95] | 1 study · 564 participants | Moderate Downgraded: risk of bias |
Medication reconciliation: pharmacist versus other professionals
Population: adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Medication errors ( Medication reconciliation: pharmacist vs other professionals | OR 0.21 [0.09, 0.48] | 8 studies · 2648 participants | Low Downgraded: inconsistency |
ADEs ( Medication reconciliation: pharmacist vs other professionals | OR 1.34 [0.73, 2.44] | 3 studies · 2873 participants | Low Downgraded: risk of bias, imprecision |
Mortality during hospitalisation ( Medication reconciliation: pharmacist vs other professionals | RR 0.99 [0.57, 1.73] | 2 studies · 1000 participants | Moderate Downgraded: imprecision |
Readmission at 1 month ( Medication reconciliation: pharmacist vs other professionals | RR 0.93 [0.76, 1.14] | 2 studies · 997 participants | Moderate Downgraded: imprecision |
Length of stay (days) ( Medication reconciliation: pharmacist vs other professionals | no estimate extracted | 6 studies · 3983 participants | Low Downgraded: risk of bias, imprecision |
Quality of life (VAS 0‐10; EQ‐5D‐3L) ( Medication reconciliation: pharmacist vs other professionals | no estimate extracted | 1 study · 724 participants | Low Downgraded: risk of bias, imprecision |
Discrepancy resolution ( Medication reconciliation: pharmacist vs other professionals | OR 4.8 [1.81, 12.76] | 3 studies · 1449 participants | Low Downgraded: risk of bias, inconsistency |
Medication reconciliation by pharmacist: database‐assisted MR versus unassisted MR
Population: adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Potential ADEs ( ≥ 1 per patient) ( Medication reconciliation by pharmacist: database‐assisted MR vs unassisted MR | OR 0.26 [0.1, 0.64] | 2 studies · 3326 participants | Low Downgraded: risk of bias, inconsistency |
Length of stay (days) ( Medication reconciliation by pharmacist: database‐assisted MR vs unassisted MR | no estimate extracted | 1 study · 311 participants | Low Downgraded: risk of bias, imprecision |
Discrepancy resolution ( Medication reconciliation by pharmacist: database‐assisted MR vs unassisted MR | OR 1.37 [0.97, 1.93] | 2 studies · 791 participants | Low Downgraded: imprecision, inconsistency |
Medication reconciliation by trained pharmacist technician versus pharmacist
Population: adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Medication errors ( Medication reconciliation by trained pharmacist technician vs pharmacist | OR 0.65 [0.25, 1.7] | 2 studies · 306 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Length of stay (days) ( Medication reconciliation by trained pharmacist technician vs pharmacist | no estimate extracted | 1 study · 183 participants | Low Downgraded: risk of bias, imprecision |
Medication reconciliation: before versus at admission
Population: adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Identified discrepancies per patient ( Medication reconciliation: before vs at admission | no estimate extracted | 1 study · 307 participants | Low Downgraded: risk of bias, imprecision |
Medication reconciliation: 1 or 2 versus 4 charts open simultaneously
Population: adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Medication errors (ITS study) ( Medication reconciliation: 1 or 2 vs 4 charts open simultaneously | no estimate extracted | 11504 participants | Very low Downgraded: imprecision |
Medication reconciliation: multimodal intervention versus usual care
Population: adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Medication error ( Medication reconciliation: multimodal intervention vs usual care | RR 0.92 [0.87, 0.97] | 1648 participants | Very low Downgraded: risk of bias |
Potential ADEs ( Medication reconciliation: multimodal intervention vs usual care | RR 0.97 [0.86, 1.09] | 1648 participants | Very low Downgraded: risk of bias, imprecision |
Discrepancy resolution ( Medication reconciliation: multimodal intervention vs usual care | RR 2.14 [1.81, 2.53] | 1 study · 487 participants | Moderate Downgraded: risk of bias |
CPOE/CDSS compared to control/paper‐based
Population: adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Medication errors ( CPOE/CDSS vs control/paper‐based | OR 0.74 [0.31, 1.79] | 2 studies · 88 participants | Moderate Downgraded: imprecision |
ADEs ( CPOE/CDSS vs control/paper‐based | OR 0.24 [0.04, 1.5] | 2 studies · 827 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Mortality during hospitalisation ( CPOE/CDSS vs control/paper‐based | RR 1.04 [0.54, 2.01] | 1 study · 737 participants | Very low Downgraded: risk of bias, imprecision |
Length of stay (days) ( CPOE/CDSS vs control/paper‐based | no estimate extracted | 1 study · 737 participants | Very low Downgraded: risk of bias, imprecision |
Improved CPOE/CDSS versus standard CPOE/CDSS
Population: adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Medication errors ( Improved CPOE/CDSS vs standard CPOE/CDSS | OR 0.85 [0.74, 0.97] | 2 studies · 630 participants | Moderate Downgraded: risk of bias |
ADEs ( Improved CPOE/CDSS vs standard CPOE/CDSS | OR 0.82 [0.71, 0.94] | 2382 participants | Moderate Downgraded: risk of bias |
CPOE/CDSS: prioritised versus non‐prioritised alerts
Population: adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Resolved potential ADEs (per prescriptions) ( CPOE/CDSS: prioritised vs non‐prioritised alerts | no estimate extracted | 1 participants | Low Downgraded: risk of bias |
Barcoding versus no barcoding
Population: adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Medication errors ( Barcoding vs no barcoding | OR 0.69 [0.59, 0.79] | 50545 participants | Low Downgraded: risk of bias |
Organisational changes: reduced versus unreduced working hours
Population: adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Medication errors ( Organisational changes: reduced vs unreduced working hours | RR 0.83 [0.63, 1.09] | 1 study · 634 participants | Low Downgraded: risk of bias, imprecision |
Feedback on prescribing errors versus no feedback
Population: adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Medication errors ( Feedback on prescribing errors vs no feedback | OR 0.47 [0.33, 0.67] | 4 studies · 384 participants | Low Downgraded: inconsistency |
Feedback on prescribing errors versus education on prescribing errors
Population: adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Medication errors ( Feedback on prescribing errors vs education on prescribing errors | OR 0.59 [0.2, 1.76] | 2 studies · 2 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Education versus no education on prescribing or administration
Population: adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Medication errors ( Education vs no education on prescribing or administration | OR 1.21 [0.93, 1.58] | 4 studies · 30 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Dispensing system versus control
Population: adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Medication errors (surgical wards) ( Dispensing system vs control | OR 0.61 [0.47, 0.79] | 2 studies · 1775 participants | Low Downgraded: risk of bias |
Medication errors (operating rooms) ( Dispensing system vs control | OR 0.92 [0.75, 1.13] | 2 studies · 2310 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |