Medication reconciliation errors in a tertiary care hospital in Saudi Arabia: admission discrepancies and risk factors

Abstract

Background:Medication reconciliation is a major component of safe patient care. One of the main problems in the implementation of a medication reconciliation process is the lack of human resources. With limited resources, it is better to target medication reconciliation resources to patients who will derive the most benefit from it.Objective:The primary objective of this study was to determine the frequency and types of medication reconciliation errors identified by pharmacists performing medication reconciliation at admission. Each medication error was rated for its potential to cause patient harm during hospitalization. A secondary objective was to determine risk factors associated with medication reconciliation errors.Methods:This was a prospective, single-center pilot study conducted in the internal medicine and surgical wards of a tertiary care teaching hospital in the Eastern province of Saudi Arabia. A clinical pharmacist took the best possible medication history of patients admitted to medical and surgical services and compared with the medication orders at hospital admission; any identified discrepancies were noted and analyzed for reconciliation errors. Multivariate logistic regression was performed to determine the risk factors related to reconciliation errors.Results:A total of 328 patients (138 in surgical and 198 in medical) were included in the study. For the 1419 medications recorded, 1091 discrepancies were discovered out of which 491 (41.6%) were reconciliation errors. The errors affected 177 patients (54%). The incidence of reconciliation errors in the medical patient group was 25.1% and 32.0% in the surgical group (p<0.001). In both groups, the most frequent reconciliation error was the omission (43.5% and 51.2%). Lipid-lowering (12.4%) and antihypertensive agents were most commonly involved. If undetected, 43.6% of order errors were rated as potentially requiring increased monitoring or intervention to preclude harm; 17.7% were rated as potentially harmful. A multivariate logistic regression model showed that patients aged ≥65 years, polypharmacy, and prescriptions for hypoglycemic drugs and warfarin were more likely associated with reconciliation errors.Conclusion:There is a high failure rate in medication reconciliation process in patients admitted to the medical and surgical department. The reconciliation process proves to be a useful tool since nearly half of avoided reconciliation errors were unintentional and had the potential for harm. This strategy, based on our results and the difficulty of applying the process to all patients should be directed primarily to the patients at increased risk of error.

Magnitude and factors associated with medication discrepancies identified through medication reconciliation at care transitions of a tertiary hospital in eastern Ethiopia

“…A medication discrepancy identified through such reconciliation and that cannot be justified is called unintentional discrepancy; this is considered as medication reconciliation error, occurring as omission, substitution or addition, as well as discrepant dose, dosage form, and frequency [ 7 ]. The reconciliation error rate can vary based on the cause of admission or type of medication prescribed to the patient [ 8 ]. The unintended medication discrepancy has variable degree of clinically sound risk to the patients [ 3 ].…”

“…The number of medications received by a patient [ 18 , 22 ], older age, sex (woman), more frequent admission in the past 12 months and reason for patient admission were key predictors indicated in relation with potential harmful discrepancies [ 2 , 21 , 23 ]. In some studies, drug omission was reported as a frequent cause of unintended medication discrepancy [ 8 , 13 – 15 ]. To this end, knowing the magnitude of medication discrepancy and its associated factors is a critical strategy in minimizing adverse health outcomes of medication discrepancies in a tertiary care hospital.…”

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“…In the test group (60 patients), 29 DRPs were identified, out of which 26 were totally resolved and 3 partially solved as a result of pharmacist interventions. Faizan Mazhar et al, (2017), demonstrated in their study that medication reconciliation at hospital admission is an effective process to reduce unintentional medication discrepancies and medication errors in hospitalized patients 14 .…”

Clinical Pharmacist-Led Program on Medication Reconciliation and Patient Counseling in the Department of Gastroenterology

“…The information is usually given verbally, but maybe supplemented with written materials. Good communication skills are required to gain the patient's confidence and to motivate the patient to adhere to the recommended regimen [9][10][11].…”