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

Abstract

Medication reconciliation is crucial to prevent medication errors. In Denmark, primary and secondary care physicians can prescribe medication in the same electronic prescribing system known as the Shared Medication Record (SMR). However, the SMR is not always updated by physicians, which can lead to discrepancies between the SMR and patients’ actual use of medication. These discrepancies may compromise patient safety upon admission to the emergency department (ED). Here, we investigated (a) the occurrence of discrepancies, (b) factors associated with discrepancies, and (c) the percentage of patients accessible to a clinical pharmacist during pharmacy working hours. The study included all patients age ≥ 18 years who were admitted to the Hvidovre Hospital ED on three consecutive days in June 2020. The clinical pharmacists performed medicines reconciliation to identify prescribing discrepancies. In total, 100 patients (52% male; median age 66.5 years) were included. The patients had a median of 10 [IQR 7–13] medications listed in the SMR and a median of two [IQR 1–3.25] discrepancies. Factors associated with increased rate of prescribing discrepancies were age < 65 years, time since last update of the SMR ≥ 115 days, and patients’ self-dispensing their medications. Eighty-four percent of patients were available for medicines reconciliations during the normal working hours of the clinical pharmacist. In conclusion, we found that discrepancies between the SMR and patients’ actual medication use upon admission to the ED are frequent, and we identified several risk factors associated with the increased rate of discrepancies.

Developing a pharmacist-led intervention to provide transitional pharmaceutical care for hospital discharged patients: A collaboration between hospital and community pharmacists

“…All healthcare professionals, including HPs and CPs, can access this platform with consent from the patient. SMR should be reconciled in care transitions, 26 , 27 and thus the SMR needs to be updated at hospital discharge by a hospital doctor.…”

Enhancing healthcare access for an older population: The age‐friendly emergency department

“… 58 , 59 , 62 However, medication reconciliation takes ∼30 min per patient, and even longer for comprehensive medication reviews. 70 Further, early assessment of geriatric patients in the ED by telemedical consultation with a geriatrician significantly reduced the number of PIMs. 63 Computerized clinical decision support tools can also be effective for obtaining an accurate medication review, 64 in addition to supporting ED clinicians in reducing polypharmacy, the rate of PIM prescribing, and subsequent ADEs.…”

Evaluation of Medication Reconciliation Process Among Home Medication, Hospital Admission, Transition Across Different Wards, and Discharge in Mizan Tepi University Teaching Hospital South West Ethiopia: A Prospective Cross-Sectional Study

“…Medication reconciliation is the "process of identifying the most accurate list of all medications a patient is taking [1][2][3][4][5][6][7][8][9][10][11][12][13] Medication discrepancies are de ned as unexplained changes to patients' medication among regimens across different care sites [1][2][3][4][5][6][7][8][9][10][11][12][13] Omission; canceling of a pre-admission prescription medication [9,10,11,12,13].…”

“…From 36(42.35%) Intentional discrepancies identi ed 'different dose' was the most frequent intentional discrepancy identi ed which account around (15,41.66%) followed by 'medications Omission' and 'different medications' (9,25%) and (6,16.66%) respectively. Of thus unintentional discrepancies [(48,56.65%)] , 'medication Omission' was the most frequent discrepancy identi ed which account around (17, 34.69% ) followed by 'different dose' and 'different frequency'(13,26.53%) and(11,22.45%) ( Table3)…”