Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review

Tam, Vincent C.; Knowles, Sandra R.; Cornish, Patricia; Fine, Nowell M.; Marchesano, Romina; Etchells, Edward

doi:10.1503/cmaj.045311

Cited by 663 publications

(588 citation statements)

References 13 publications

(36 reference statements)

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“…mostly errors of omission or commission) were similar to prior studies. 1,3,12,14,15,23,25 Several factors we found to be associated with medication reconciliation errors, such as older age and number of preadmission medications, were confirmed by others. 11,12,14,15 However, in one study fewer unintentional medication discrepancies were associated with age over 85 compared to age less than 50.…”

Section: Discussionsupporting

confidence: 77%

“…A systematic review of PAML error studies revealed that 10-67% of patients had at least 1 PAML error upon admission. 1 Admission order errors occurred slightly more often in several, 3,[22][23][24] but not all, 11 prior studies. Our incidence of discharge medication errors is within the 25-71% incidence found in other studies.…”

Section: Discussionmentioning

confidence: 98%

“…One study reported that 67% of inpatients had at least one error on their admission medication lists. 1 These errors can increase the risk of adverse drug events (ADEs) during hospitalization or following discharge. [2][3][4] Hospitals attempt to avert medication errors and ADEs by implementing medication reconciliation, the process by which a clinician compiles an accurate list of all medications that an individual is currently taking [5][6][7] and uses that list to provide correct medications anywhere within the health care system.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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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.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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“…Numerous studies have demonstrated high rates of errors in admission medication lists. 2 Therefore, the true rate of medication errors at discharge compared to patients' pre-admission medication regimen is likely higher. On the other hand, we were not able to communicate with hospital providers directly regarding suspected provider errors, and it is therefore possible that some changes we categorized as likely errors were actually intentional.…”

Section: Discussionmentioning

confidence: 99%

“…On admission, medication reconciliation is prone to error with an estimated 67 % of medication histories being inaccurate, thereby contributing to 27 % of inpatient provider errors. 2 Inpatient transfers between units are an additional source of risk for medicaAuthor Contributions Dr. Horwitz had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Horwitz.…”

Section: Introductionmentioning

confidence: 99%

Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge

et al. 2012

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BACKGROUND: Adverse drug events after hospital discharge are common and often serious. These events may result from provider errors or patient misunderstanding. OBJECTIVE: To determine the prevalence of medication reconciliation errors and patient misunderstanding of discharge medications. DESIGN: Prospective cohort study SUBJECTS: Patients over 64 years of age admitted with heart failure, acute coronary syndrome or pneumonia and discharged to home. MAIN MEASURES:We assessed medication reconciliation accuracy by comparing admission to discharge medication lists and reviewing charts to resolve discrepancies. Medication reconciliation changes that did not appear intentional were classified as suspected provider errors. We assessed patient understanding of intended medication changes through post-discharge interviews. Understanding was scored as full, partial or absent. We tested the association of relevance of the medication to the primary diagnosis with medication accuracy and with patient understanding, accounting for patient demographics, medical team and primary diagnosis. KEY RESULTS: A total of 377 patients were enrolled in the study. A total of 565/2534 (22.3 %) of admission medications were redosed or stopped at discharge. Of these, 137 (24.2 %) were classified as suspected provider errors. Excluding suspected errors, patients had no understanding of 142/205 (69.3 %) of redosed medications, 182/223 (81.6 %) of stopped medications, and 493 (62.0 %) of new medications. Altogether, 307 patients (81.4 %) either experienced a provider error, or had no understanding of at least one intended medication change. Providers were significantly more likely to make an error on a medication unrelated to the primary diagnosis than on a medication related to the primary diagnosis (odds ratio (OR) 4.56, 95 % confidence interval (CI) 2.65, 7.85, p<0.001). Patients were also significantly more likely to misunderstand medication changes unrelated to the primary diagnosis (OR 2.45, 95 % CI 1.68, 3.55), p<0.001). CONCLUSIONS: Medication reconciliation and patient understanding are inadequate in older patients postdischarge. Errors and misunderstandings are particularly common in medications unrelated to the primary diagnosis. Efforts to improve medication reconciliation and patient understanding should not be diseasespecific, but should be focused on the whole patient.

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Pharmacist Medication Assessments in a Surgical Preadmission Clinic

Kwan

Fernandes²,

Nagge³

et al. 2007

Arch Intern Med

144

151

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Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review

Cited by 663 publications

References 13 publications

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

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

Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge

Pharmacist Medication Assessments in a Surgical Preadmission Clinic

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