Discrepancies Between the Medication List in Electronic Prescribing Systems and Patients' Actual Use of Medicines

Abstract

Discrepancies between electronic prescribing systems and patients' actual use of medicines can result in adverse events and medication errors and have serious consequences for the patients. The discrepancies can be identified when performing a thorough medication reconciliation. Computerized health care systems throughout the Danish health care sector are integrated with the Shared Medication Record (SMR). In the SMR, current medication and medication prescriptions are registered. The aim of this study was to evaluate the number and types of discrepancies between medications listed in the SMR and an updated medication list, obtained through a thorough medication reconciliation, for patients admitted in Danish hospitals. Pharmacists listed the number and type of discrepancies for 412 patients. A total of 1,004 discrepancies were registered, with a mean number of 2.4 medication discrepancies per patient. For 25% (n = 101) of the patients, no discrepancies were found, 20% (n = 86) had one discrepancy, and 16% (n = 66) had five or more discrepancies. More than 50% of the patients had one or more medications in the SMR that the patient did not administer, and 12.6% used medications that were not listed in the SMR. This shows that the SMR should not be used as the only source of information when recording medication history.

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

“…The types of discrepancies found in our study are comparable to other Danish studies [15,16,18,25]. We found that 65% of discrepancies were due to medication being no longer in use, which is similar to results from Bülow et al 2019 [16] and Bülow et al 2021 [15] but higher than results from Buck et al [18].…”

“…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.…”

“…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.…”

“…We found that 15% of discrepancies were due to errors in dosing frequency. The two studies by Bülow [15,16] divide this category into two subcategories: PRN administration of regularly scheduled prescriptions, and regular scheduled administration of a PRN prescription. If these categories are merged, then the combined frequency of discrepancies found due to errors in dosing frequency from Bülow et al 2019 [16] is similar to our study, but the frequency in Bülow et al 2021 [15] is more than double what we observed.…”

“…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.…”