Omitted and unjustified medications in the discharge summary
ABSTRACT Limited information exists in regard to drug omissions and unjustified medications in the hospital discharge summary (DS).
To evaluate the incidence and types of drug omissions and unjustified medications in the DS, and to assess their potential impact on patient health.
A prospective observational review of the DSs of all patients discharged from our Internal Medicine Department over a 3-month period. Data assessment was made by internists using a structured form.
Of the 577 evaluated DSs, 66% contained at least one inconsistency accounting for a total of 1012 irregularities. There were 393 drug omissions affecting 251 patients, 32% of which were potentially harmful. Seventeen per cent of all medications (619/3691) were unjustified, affecting 318 patients. The unjustified medication was potentially harmful in 16% of cases, occurred significantly more frequent in women than in men (61% vs 50%; p = 0.008) and increased linearly with the number of drugs prescribed (p<0.001). Drug omission had a twofold higher potential to cause harm than unjustified medication.
Drug omissions and unjustified medications are frequent, and systemic changes are required to substantially reduce these inconsistencies.
SourceAvailable from: Michael Roberts[Show abstract] [Hide abstract]
ABSTRACT: Background Accurate and timely medication information at the point of discharge is essential for continuity of care. There are scarce data on the clinical significance if poor quality medicines information is passed to the next episode of care. This study aimed to compare the number and clinical significance of medication errors and omission in discharge medicines information, and the timeliness of delivery of this information to community-based health practitioners, between the existing Hospital Discharge Summary (HDS) and a pharmacist prepared Medicines Information Transfer Fax (MITF). Method The study used a sample of 80 hospital patients who were at high risk of medication misadventure, and who had a MITF completed in the study period June – October 2009 at a tertiary referral hospital. The medicines information in participating patients’ MITFs was validated against their Discharge Prescriptions (DP). Medicines information in each patient’s HDS was then compared with their validated MITF. An expert clinical panel reviewed identified medication errors and omissions to determine their clinical significance. The time between patient discharge and the dispatching of the MITF and the HDS to each patient’s community-based practitioners was calculated from hospital records. Results DPs for 77 of the 80 patients were available for comparison with their MITFs. Medicines information in 71 (92%) of the MITFs matched that of the DP. Comparison of the HDS against the MITF revealed that no HDS was prepared for 16 (21%) patients. Of the remaining 61 patients; 33 (54%), had required medications omitted and 38 (62%) had medication errors in their HDS. The Clinical Panel rated the significance of errors or omissions for 70 patients (16 with no HDS prepared and 54 who’s HDS was inconsistent with the validated MITF). In 17 patients the error or omission was rated as insignificant to minor; 23 minor to moderate; 24 moderate to major and 6 major to catastrophic. 28 (35%) patients had their HDS dispatched to their community-based practitioners within 48 hours post discharge compared to 80 (100%) of MITFs. Conclusion The MITF is an effective approach for the timely delivery of accurate discharge medicines information to community-based practitioners responsible for the patient’s ongoing care.BMC Health Services Research 12/2012; 12(1):453. DOI:10.1186/1472-6963-12-453 · 1.66 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Transitional care has become one of the most pressing topics in the global efforts to improve the reliability and safety of patients due to the growing evidence indicating the strong correlation of patient handovers with medical errors and adverse events. The elderly population with typically complex health problems frequently requires care in multiple settings. Elders appear to be a group particularly at risk for medical errors in general and during transitions between settings. This population is especially vulnerable for experiencing communication related adverse outcomes and problems of care fragmentation. Existing research has primarily been concerned with adverse events and medical errors occurring within the hospital. Review of the literature reveals that relatively little data is available to estimate the extent and impact of adverse events occurring during the transitions interface between primary and secondary health and care services. Despite the lack of empirical research a common message in existing literature is that adverse events occur in transitional care of the elderly. The major contributing risk factors for adverse events are ineffective care processes and poor communication. The type and incidence of adverse events reported in the literature are related to drug events, procedure related events, diagnostic test follow-up errors, nosocomial infections and falls. The severity of these adverse events varies from laboratory errors only to permanent disability and death. Risk factors related to transitional care should be recognized as a high yield area of intervention and improvement. This is particularly evident given the increasing elderly population and their repeated hospitalizations, iatrogenic complications, and uncoordinated care due to poorly executed transitions.
[Show abstract] [Hide abstract]
ABSTRACT: Background Patients are particularly susceptible to medical error during transitions from inpatient to outpatient care. We evaluated discharge summaries produced by incoming postgraduate year 1 (PGY-1) internal medicine residents for their completeness, accuracy, and relevance to family physicians. Methods Consecutive discharge summaries prepared by PGY-1 residents for patients discharged from internal medicine wards were retrospectively evaluated by two independent reviewers for presence and accuracy of essential domains described by the Joint Commission for Hospital Accreditation. Family physicians rated the relevance of a separate sample of discharge summaries on domains that family physicians deemed important in previous studies. Results Ninety discharge summaries were assessed for completeness and accuracy. Most items were completely reported with a given item missing in 5% of summaries or fewer, with the exception of the reason for medication changes, which was missing in 15.9% of summaries. Discharge medication lists, medication changes, and the reason for medication changes—when present—were inaccurate in 35.7%, 29.5%, and 37.7% of summaries, respectively. Twenty-one family physicians reviewed 68 discharge summaries. Communication of follow-up plans for further investigations was the most frequently identified area for improvement with 27.7% of summaries rated as insufficient. Conclusions This study found that medication details were frequently omitted or inaccurate, and that family physicians identified lack of clarity about follow-up plans regarding further investigations and visits to other consultants as the areas requiring the most improvement. Our findings will aid in the development of educational interventions for residents.BMC Medical Education 08/2012; 12(1):77. DOI:10.1186/1472-6920-12-77 · 1.41 Impact Factor