Effectiveness Of Electronic Medication Reconciliation In Reducing Adverse Drug Events In Pediatric Inpatients: A Systematic Review And Meta-Analysis

Background: Fragmented caregiver histories, incomplete interoperability, and age-based formulations and weight-dosing all pose additional hurdles to pediatric medication reconciliation when compared to standard medication reconciliation. Electronic workflows may provide improvements to the accuracy and completion of medication reconciliation, but the impact on adverse drug events is still unknown. The goal of this study is to integrate the available pediatric inpatient evidence regarding the use of electronic medication reconciliation and measure the burden of medication discrepancies. This was completed using a PRISMA 2020-rooted systematic review. This review used publicly available bibliographic sources, publisher sources, and citation searching, and was active until 31 December 2025. This systematic review included studies on electronic, paper-based, and telephone frameworks that facilitated medication reconciliation, and were conducted on hospitalized children and adolescents aged 0 to 18. The included studies primarily focused on electronic or digitally facilitated medication reconciliation. These studies had a wide range of designs and outcomes which necessitated narrative synthesis. The remaining studies were included in a random-effects meta-analysis to estimate the prevalence of medication reconciliation error for the four remaining studies on pediatric inpatient settings. This was done using a logit transformed meta-analysis. The remaining studies were assessed for risk of bias and low certainty of evidence was provided by the GRADE framework. Out of the 11 studies, 6 of them focused directly on digital or electronic-based interventions. All these studies saw some level of improvement to the accuracy of the electronic medication reconciliation, reductions in electronic medication reconciliation error rates, and improvements to the completion of the electronic medication reconciliations. However, none of the studies provided sufficient evidence, in a concurrent controlled framework, to draw conclusions on adverse drug events and electronic medication reconciliation, which necessitated qualitative evidence synthesis. Four studies that were included in the meta-analysis had a combined total of 1050 individual subjects, all of whom were children. The pooled study prevalence estimates for reconciliation error or discrepancy was 58.8% (95% CI, 45.0 to 71.2), and a high I2 score (90.2) indicated extensive variability of the studies. Defining discrepancies in pediatric electronic medication reconciliation systems yielded a very low certainty of evidence due to the differing study designs and objectives across clinical settings and participant populations. Conclusion: When workflow enhancements by pharmacists or multidisciplinary teams are integrated with EHR design alterations, the combination is evidence to further support the optimizing work processes associated with pediatric electronic medication reconciliation. Current evidence is inadequate to assert that redesigning work processes prevents the occurrence of adverse drug events. To change this, studies that analyze the harmonization of patient-centered outcomes after the implementation of work design solutions are needed. Registration: There is currently no public protocol to cite. Keywords: Adverse Drug Events; Clinical Decision Support; Electronic Health Records; Medication Discrepancies; Medication Reconciliation; Patient Safety; Pediatrics; Transitions Of Care