Causes of discrepancies between medications listed in the national electronic prescribing system and patients' actual use of medications

Abstract

Discrepancies between registered prescriptions and patients' actual use of medications are described as frequent and often resulting in adverse medication events. We aimed to assess the extent of and causes behind discrepancies between medications listed in the Danish national prescription system (Shared Medication Record) and patients' actual use of medications. We prospectively reconciled medication for 260 consecutively admitted polypharmacy patients (>50 years and ≥5 prescriptions) at two hospitals in the Capital Region of Denmark. The type of discrepancies were determined and the cause of the discrepancies were evaluated as primarily caused by (1) the patient (i.e., intentional or unintentional non‐adherence) or (2) the health care system (i.e., lack of appropriate update of the SMR by physicians in primary or secondary care). There was a median of 12 [IQR 9–15] medications listed and 3 [IQR 1–5] medication discrepancies per patient (total n = 925). The majority (53%) of discrepancies were caused by the health care system, 32% were caused by the patients, of which 70% were intentional non‐adherence, and 15% had an indeterminable cause. In conclusion, discrepancies between medications listed in the Shared Medication Record and actual use of medications were frequent and were most often caused by clinicians not updating the prescription information.

Medicines Reconciliation in the Emergency Department: Important Prescribing Discrepancies between the Shared Medication Record and Patients’ Actual Use of Medication

“…In Denmark, patients who receive help with dispensing their medication via home care, district nurses, or care assistants, get their medicines dispensed directly from orders in the SMR. The association between discrepancies and time since prior SMR update observed in our study is similar to findings from Bülow et al 2021 [15]. Cornich et al did not find a significantly higher discrepancy rate for admissions that took place outside of normal working hours [24].…”

“…The frequency of discrepancies upon ED admission were lower than what has been observed in other Danish studies [15,16,18]. This may be explained by differences in clinical setting and inclusion criteria.…”

“…For example, Buck et al and Bülow et al studied patients in the ED, geriatric ward, and the orthopedic surgery ward. Their inclusion criteria were age >50 years with ≥5 medications [15,18]. It has previously been demonstrated that increased medication use is associated with an increased risk of discrepancies [19][20][21][22], so the findings by Bülow et al 2019 [16], Bülow et al 2021 [15] and Buck et al [18] may be related to the higher prevalence of polypharmacy.…”

“…Their inclusion criteria were age >50 years with ≥5 medications [15,18]. It has previously been demonstrated that increased medication use is associated with an increased risk of discrepancies [19][20][21][22], so the findings by Bülow et al 2019 [16], Bülow et al 2021 [15] and Buck et al [18] may be related to the higher prevalence of polypharmacy. These studies did not find an association between age and the frequency of discrepancies found, which is likely due to the difference in clinical settings compared to our study.…”

“…Previous studies have shown that the SMR is not used as intended by physicians during medicines reconciliation [15][16][17], but it is unknown how often discrepancies occur in the emergency department (ED). Therefore, the purpose of this study is to investigate (a) the number and types of discrepancies, (b) the factors associated with discrepancies, and (c) the number of medicines reconciliations that could realistically be completed by a clinical pharmacist.…”