Improving medication safety with proactive reconciliation in acute coronary syndrome patients: A randomized trial

Background

Patients with acute coronary syndrome (ACS) are at an increased risk of medication errors due to the complexity of medication regimens, frequent transitions of care, the use of high-risk medications, and their vulnerability to adverse events.

Objective

This randomized controlled trial aimed to compare the effectiveness and time efficiency of proactive versus retroactive medication reconciliation models in preventing unintentional medication discrepancies in patients hospitalized with ACS.

Methods

Conducted from January to June 2024 at a specialty cardiovascular teaching hospital in West Iran, the study included 162 eligible patients admitted to the coronary care unit (CCU) with a diagnosis of ACS and taking at least five regular medications. Patients were randomly assigned to either the proactive or retroactive reconciliation group (81 each). A clinical pharmacist led both reconciliation models, supported by trained pharmacy interns who conducted patient interviews to obtain detailed medication histories. Primary outcome measures included the number and types of unintentional medication discrepancies identified, as well as their potential harm.

Results

A total of 654 medications were reconciled using the proactive approach, compared to 627 with the retroactive method. Among the discrepancies identified, 13 % were unintentional in the proactive group, whereas 44 % were unintentional in the retroactive group (p < 0.001). Additionally, 66.7 % of patients in the retroactive group had at least one discrepancy, compared to 38.3 % in the proactive group (p < 0.001). The average number of unintentional discrepancies per patient was significantly lower in the proactive approach (0.6) than in the retroactive model (1.7; p < 0.001). Over 51 % of errors in the retroactive group had the potential for moderate or severe harm, while most errors in the proactive model were assessed as having only mild harm (86.5 %; p < 0.001). The acceptance rate of pharmacist recommendations regarding unintentional medication discrepancies was higher in the retroactive reconciliation group compared to the retroactive group (68 % vs. 21 %; p < 0.001), and physicians reported greater satisfaction with the proactive method. Furthermore, the proactive model demonstrated superior time efficiency in completing the medication reconciliation process and resolving discrepancies.

Conclusions

Our findings demonstrate that the proactive model of medication reconciliation is more time-efficient and effective in preventing unintentional medication discrepancies in patients hospitalized with ACS compared to the retroactive approach.

Trial registration

The trial was registered at Iranian Registry of Clinical Trials (https://irct.behdasht.gov.ir/trial/74760, identifier code: IRCT20120215009014N494). Registration date: 2024-01-02.