Medication details documented on hospital discharge: cross‐sectional observational study of factors associated with medication non‐reconciliation

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Managing a patient's medication(s) at points around transfer of care is central to patient safety and high quality care.• Medication use at these points carries the potential for miscommunication and medication error.• Processes of reconciliation can help to reduce the prevalence of miscommunication and error, improve continuity of appropriate medication use and improve communication across different settings. However, such processes are resource intensive. WHAT THIS PAPER ADDS• Medication details documented at discharge from acute hospital care in Ireland frequently contain prescription writing errors or fail to communicate information regarding changes made during inpatient care (collectively referred to as nonreconciliations).This carries the potential to cause harm or unplanned re-admission.• The medication classes that are more likely to be omitted at admission or discharge were identified, as were those involved in failure to document changes made during inpatient care, for example stopping or withholding.• Patients experiencing chronic illness and using an increasing number of medications were identified as being at greatest risk of experiencing non-reconciliation, and it is recommended that processes of reconciliation should be prioritized for these patients.• Processes that require the same medication details to be written more than once increase the likelihood of non-reconciliation. AIMSMovement into or out of hospital is a vulnerable period for medication safety.Reconciling the medication a patient is using before admission with the medication prescribed on discharge, and documenting any changes (medication reconciliation) is recommended to improve safety.The aims of the study were to investigate the factors contributing to medication reconciliation on discharge, and identify the prevalence of non-reconciliation. METHODSThe study was a cross-sectional, observational survey using consecutive discharges from purposively selected services in two acute public hospitals in Ireland. Medication reconciliation, potential for harm and unplanned re-admission were investigated. RESULTSMedication non-reconciliation was identified in 50% of 1245 inpatient episodes, involving 16% of 9569 medications.The majority of non-reconciled episodes had potential to result in moderate (63%) or severe (2%) harm. Handwritten rather than computerized discharges (adjusted odds ratio (adjusted OR) 1.60, 95% CI 1.11, 2.99), increasing number of medications (adjusted OR 1.26, 95% CI 1.21, 1.31) or chronic illness (adjusted OR 2.08, 95% CI 1.33, 3.24) were associated with non-reconciliation. Omission of endocrine, central nervous system and nutrition and blood drugs was more likely on discharge, whilst omission on admission and throughout inpatient care, without documentation, was more likely for obstetric, gynaecology and urinary tract (OGU) or respiratory drugs. Documentation in the discharge communication that medication was intentionally stopped during inpatient care was less likely for c...

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

“…[4][5][6][7][8][9][10] There was no difference in error rates between patients cared for by hospitalists or cardiology attendings and those cared for by house staff, suggesting that clinical experience and expertise are not adequate protections against medication errors at discharge. By contrast, a recent study of an electronic medication reconciliation intervention demonstrated a reduction in provider errors.…”

“…3 A further set of errors can be made at the time of hospital discharge. [4][5][6][7][8][9][10] Errors include unintentional discontinuation of medication on discharge, [4][5][6][7] inappropriate retention of inpatient medications on discharge, 7,8 and inaccurate changes in dosing or frequency. Medication reconciliation inaccuracies accumulating at all these points of transition create substantial risk for medication errors on hospital discharge.…”

“…For example, an observational study in Ireland found that 50 % of discharge medication reconciliations during 1,245 hospitalizations were inaccurate, involving 16 % of all medications prescribed. 10 Equally important is patient understanding of the discharge medication regimen, particularly given that nearly half of all home medications regimens are modified via changes in dose, discontinuation, or new prescriptions after hospitalization. 10,11 A 1999 study of 342 patients found that 54 % had inadequate knowledge of their medications 1 week after discharge; 12 other smaller studies show similar results.…”

“…10 Equally important is patient understanding of the discharge medication regimen, particularly given that nearly half of all home medications regimens are modified via changes in dose, discontinuation, or new prescriptions after hospitalization. 10,11 A 1999 study of 342 patients found that 54 % had inadequate knowledge of their medications 1 week after discharge; 12 other smaller studies show similar results. [13][14][15][16][17] Nonetheless, physicians grossly overestimate patient understanding.…”

Segurança do paciente no uso de medicamentos após a alta hospitalar: estudo exploratório1

“…In a study involving 1,245 episodes of outpatient care with post-discharge patients, Grimes et al (2011) found that in 50.1% of cases there was at least one prescribing error or lack of documenting or communicating treatment alterations, either in the discharge prescription or discharge summary. Corry et al (2000) found that the information on hospital letters sent to primary care are insufficient to adequately monitor the pharmacotherapy.…”