Inpatient medication reconciliation at admission and discharge: A retrospective cohort study of age and other risk factors for medication discrepancies

Abstract

Background Medication discrepancies are unintended differences between medication regimens (ie, between a patient’s home regimen and medications prescribed on admission to the hospital). Objective The goal of this study was to describe the incidence, drug classes, and probable importance of hospital admission medication discrepancies and discharge regimen differences, and to determine whether factors such as age and specific hospital services were associated with greater frequency of medication discrepancies and differences. Methods This was a retrospective cohort study of a random sample of adult patients admitted to the general medicine, cardiology, or general surgery services of a tertiary care academic teaching hospital between July 1, 2006, and August 31, 2006. A chart review was performed to collect the following information: patient demographic characteristics, comorbid conditions, number of preadmission medications, discrepant medications identified by the hospital’s reconciliation process, reasons for the discrepancies, and discharge medications that differed from the home regimen. Potentially high-risk discrepancies and differences were identified by determining if the medications were included on either the Institute for Safe Medication Practices high-alert list or the North Carolina Narrow Therapeutic Index list. Univariate and multivariate logistic regression analyses were used to identify factors associated with medication discrepancies and differences. Results Of the 205 patients (mean age, 59.9 years; 116 men, 89 women; 60% white) included in the study, 27 did not have any medications recorded on admission. Of the 178 patients who did have medications listed, 41 had ≥1 discrepancy identified by the reconciliation process on admission (23%; 95% CI, 17–29); 19% (95% CI, 11–31) of these medications were considered to be potentially high risk. In the multivariate logistic regression model, age (odds ratio [OR] per 5-year increase = 1.16; 95% CI, 1.01–1.33; P = 0.035), presence of high-risk medications on admission (OR = 76.68; 95% CI, 9.13–643.76; P < 0.001), and general surgery service (OR = 3.31; 95% CI, 1.40–7.87; P < 0.007) were associated with a higher proportion of patients with discrepancies on admission. At discharge, 196 patients (96% [95% CI, 93–98]) had ≥1 medication change from their home regimen, with 1102 total differences for 205 patients. Less than half (44% [95% CI, 37–51]) of these patients were explicitly alerted at discharge to new medications or dose changes; 12% (95% CI, 7–18) were given written instructions to stop taking discontinued home medications. Cardiovascular drugs were the most frequent class involved at both admission (31%) and discharge (27%) in medication discrepancies or differences. Conclusions Medication discrepancies on admission and medication differences at discharge were prevalent for adult patients admitted to the general medicine, cardiology, and general surgery services in this academic teaching hospital. Medication reconciliation processes have a...

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

“…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. 12 Herrero-Herrero et al found that the number of preadmission medications predicted unjustified discrepancies (i.e.…”

“…We did not investigate medication errors from in-hospital transfers nor assess the clinical impact of medication errors, though the relationship between total errors, clinically relevant errors, and ADEs have been described in several prior studies. 3,4,11,12,14,15,22,23,34 Clinically relevant medication errors were classified at the discretion of the pharmacists, thereby introducing possible bias in the judgment of these outcomes. The potential of errors to cause harm was not formally adjudicated by a blinded panel of clinicians.…”

“…11 Little research has examined how patient characteristics and other factors affect the medication reconciliation process-those that have are generally small, single site studies (or two sites within one hospital system). [11][12][13][14][15] Also few studies have examined how errors in the medication history-taking process (PAML errors) affect the likelihood of discharge errors.…”

Relationship of Health Literacy to Intentional and Unintentional Non-Adherence of Hospital Discharge Medications

“…Medication discrepancies frequently occur surrounding an acute hospitalization, both at admission and at discharge., [1][2][3] Medication discrepancies are differences between medication regimens (i.e. between medications prescribed on discharge from the hospital and a patient's home regimen).…”

Estratégias para a segurança do paciente no processo de uso de medicamentos após alta hospitalar

“…Entretanto, apenas 44% foram alertados explicitamente sobre novos medicamentos prescritos ou alterações de doses, e 12% receberam instruções por escrito para parar de utilizar medicamentos que faziam uso antes da hospitalização e que foram suspensos (UNROE et al, 2010).…”