Information Quality A Major Consideration in the Development of Medication Liaison Services

Abstract

Objective: To assess the accuracy of medication-related information as a preliminary phase to the development of a comprehensive medication liaison service. Method: During a 30-minute post-admission interview, the pharmacist research officer compiled a demographic profile, medical history, and a comprehensive drug use history on 208 randomly selected inpatient admissions. Multiple information sources were then evaluated to cross validate the above information and to resolve conflicts with medication profiles charted by the admitting physicians. All medication changes during the admission, and subsequent discharge medication profiles, length of stay, diagnoses and co-morbidities were recorded. Results: For the study sample, medication-related information was complex in terms of the variability in data; large numbers of medications, frequency of changes made, and numerous information discrepancies. Inconsistencies between information charted by the admitting doctor and that obtained from other accessible information sources were common; e.g. 0.5 ± 1.0 (mean ± SD) medications (range 0-5) were unintentionally omitted from admission drug lists, while 1.38 ± 2.04 (range 0-12) medications current on the medication chart were omitted in error from the discharge prescription. Conclusion: The findings of this study support the need for pharmacists to improve the processes by which medication-related information is collected and managed; to ensure that accurate patient data are available to facilitate medication decision making in both hospital and community environments.

Continuation of Proton Pump Inhibitors from Hospital to Community

“…The quality of discharge information in the present study was similar to that previously reported in similar settings, and could be improved by using discharge medication cards, automated electronic discharge summaries or medication liaison services [7,8].…”

“…Thus hospital-initiated prescribing may have some influence on increased use of PPIs in the community. The quality of communication between hospital and primary care may also influence subsequent prescribing, such as choice of drug, dose and duration of therapy [7,8]. Hence our hypothesis was that the hospital initiation of PPIs, appropriately or otherwise, and the quality of hospital discharge information, might influence the continuation of PPI therapy in primary care.…”

Reducing medication errors in hospital discharge summaries: a randomised controlled trial

“…Another study undertaken to assess the accuracy of medication-related information in the medical record found on average one medicine was omitted from the discharge prescription. There were also problems with the medication history on admission with, on average, one medicine not being documented on the medication history for every two patients (Stowasser et al 1997). How often these omission errors lead to actual adverse drug events or patient harm has not been reported.…”

The effect on medication errors of pharmacists charting medication in an emergency department

“…Discontinuity of care contributes to suboptimal use of medicines and significant associated patient harm [2]. One Australian study revealed one in two patients had an incomplete medication list on admission to hospital, with subsequent medication omissions and potential patient harm [3]. Medication reconciliation is a strategy that is used to address discontinuity of care in medication management.…”