Effect of Patient- and Medication-Related Factors on Inpatient Medication Reconciliation Errors

Abstract

BACKGROUND:Little research has examined the incidence, clinical relevance, and predictors of medication reconciliation errors at hospital admission and discharge. OBJECTIVE: To identify patient-and medication-related factors that contribute to pre-admission medication list (PAML) errors and admission order errors, and to test whether such errors persist in the discharge medication list. DESIGN, PARTICIPANTS: We conducted a crosssectional analysis of 423 adults with acute coronary syndromes or acute decompensated heart failure admitted to two academic hospitals who received pharmacistassisted medication reconciliation during the Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) Study. MAIN MEASURES:Pharmacists assessed the number of total and clinically relevant errors in the PAML and admission and discharge medication orders. We used negative binomial regression and report incidence rate ratios (IRR) of predictors of reconciliation errors. KEY RESULTS: On admission, 174 of 413 patients (42%) had ≥1 PAML error, and 73 (18%) had ≥1 clinically relevant PAML error. At discharge, 158 of 405 patients (39%) had ≥1 discharge medication error, and 126 (31%) had ≥1 clinically relevant discharge medication error. Clinically relevant PAML errors were associated with older age (IRR=1.46; 95% CI, 1.00-2.12) and number of pre-admission medications (IRR=1.17; 95% CI, 1.10-1.25), and were less likely when a recent medication list was present in the electronic medical record (EMR) (IRR=0.54; 95% CI, 0.30-0.96). Clinically relevant admission order errors were also associated with older age and number of pre-admission medications. Clinically relevant discharge medication errors were more likely for every PAML error (IRR=1.31; 95% CI, 1.19-1.45) and number of medications changed prior to discharge (IRR=1.06; 95% CI, 1.01-1.11). CONCLUSIONS: Medication reconciliation errors are common at hospital admission and discharge. Errors in preadmission medication histories are associated with older age and number of medications and lead to more discharge reconciliation errors. A recent medication list in the EMR is protective against medication reconciliation errors.

Medication reconciliation as a strategy for preventing medication errors

“…According to the NCCMERP classification, the majority of the errors (80%) was classified as B category (the error occurs, but does not reach the patient), followed by class C (15%) (the error reach the patient, but does not cause harm). Omission errors were also the most frequent problem identified by many authors (Lubowski et al, 2007;Pippins et al, 2008;Salanitro et al, 2012;Hellstrom et al, 2012). Dosing errors level is also in accordance with the literature (Pippins et al, 2008;Stone et al, 2010).…”

“…However, other studies found a lower proportion of harm related to drug errors. BecerraCamargo et al (2013) considered that only 42.7% of the errors could lead to a patient discomfort and Salanitro et al (2012) pointed out that only 59% of the errors could result in harm for the patient.…”

“…Some authors call attention to the difficulty of obtaining this information, the presence of incomplete data, to the inadequate communication and to the patients lack of understanding regarding their treatment. The importance of reliable drug history available before initiating reconciliation is also emphasized (Coffey et al, 2009;Salanitro et al, 2012). This aspect was particularly important in this study since it was observed constant lack of information in the medical records, which often diminished the reconciliation contribution to avoid drug related problems.…”

Characteristics Associated With Postdischarge Medication Errors

“…First, the frequency of omission (27%) and commission (36%) errors are similar to what we have reported in the PILL-CVD study, which enrolled a comparable inpatient population. 39 Furthermore, 41% of patients in the current study correctly reported the indication, dose, and frequency for tested cardiac medications. Prior studies have reported each outcome individually: 64-79% of patients reported the correct indication, 40,41 56% the correct dosage, 40 and 68% the correct frequency.…”

4CPS-208 Experience of implementation of a clinical pharmacy service in a first-level hospital in portugal

“…1 In 2006, the World Health Organisation initiated the High 5 s Project where it recommended medication reconciliation to prevent medication errors at transition points. 2 Purpose To implement and evaluate a clinical pharmacist-led medication reconciliation service in geriatric patients upon admission to hospital, in terms of frequency, type and potential severity of the medication errors identified.…”