Article

Errors in medication history at hospital admission: Prevalence and predicting factors

eHealth Institute and School of Natural Sciences, Linnaeus University, Kalmar, Sweden.
BMC Clinical Pharmacology (Impact Factor: 1.36). 04/2012; 12(1):9. DOI: 10.1186/1472-6904-12-9
Source: PubMed

ABSTRACT

An accurate medication list at hospital admission is essential for the evaluation and further treatment of patients. The objective of this study was to describe the frequency, type and predictors of errors in medication history, and to evaluate the extent to which standard care corrects these errors.
A descriptive study was carried out in two medical wards in a Swedish hospital using Lund Integrated Medicines Management (LIMM)-based medication reconciliation. A clinical pharmacist identified each patient's most accurate pre-admission medication list by conducting a medication reconciliation process shortly after admission. This list was then compared with the patient's medication list in the hospital medical records. Addition or withdrawal of a drug or changes to the dose or dosage form in the hospital medication list were considered medication discrepancies. Medication discrepancies for which no clinical reason could be identified (unintentional changes) were considered medication history errors.
The final study population comprised 670 of 818 eligible patients. At least one medication history error was identified by pharmacists conducting medication reconciliations for 313 of these patients (47%; 95% CI 43-51%). The most common medication error was an omitted drug, followed by a wrong dose. Multivariate logistic regression analysis showed that a higher number of drugs at admission (odds ratio [OR] per 1 drug increase = 1.10; 95% CI 1.06-1.14; p < 0.0001) and the patient living in their own home without any care services (OR = 1.58; 95% CI 1.02-2.45; p = 0.042) were predictors for medication history errors at admission. The results further indicated that standard care by non-pharmacist ward staff had partly corrected the errors in affected patients by four days after admission, but a considerable proportion of the errors made in the initial medication history at admission remained undetected by standard care (OR for medication errors detected by pharmacists' medication reconciliation carried out on days 4-11 compared to days 0-1 = 0.52; 95% CI 0.30-0.91; p=0.021).
Clinical pharmacists conducting LIMM-based medication reconciliations have a high potential for correcting errors in medication history for all patients. In an older Swedish population, those prescribed many drugs seem to benefit most from admission medication reconciliation.

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    • "Several studies reported decreases in medication error rates after successfully implementing medication reconciliation programmes [9] [10] [11]. However, medication information obtained directly from a patient during a first patient–physician encounter has been found to be error-prone [12] [13] [14] [15], especially in the case of elderly patients and patients affected by polypharmacy [16] [17]. To improve this situation, applications have been developed to support patients in managing their own medication list online, and to make them available to their health care providers [18]. "
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    ABSTRACT: Purpose To manage medication treatment and to assure medication safety, health care professionals need a complete overview of all drugs that have been prescribed or are taken by a patient. In 2009, Austria launched the pilot project “e-Medikation” in three pilot regions. E-Medikation gives access to a patient's nationwide medication list and includes medication safety checks. The objective of this paper is to report on the evaluation results and lessons learnt. Methods A formative evaluation study performed between July and December 2011 comprised a standardized survey of participating physicians, pharmacists, and patients, as well as an analysis of the e-Medikation log files. Results During the evaluation period, 18,310 prescriptions and 13,797 dispensings were documented, and 22,359 medication safety checks were performed. Overall, 61 physicians, 68 pharmacists, and 553 patients responded to a written survey. The results showed high acceptance of the idea of e-Medikation among pharmacists and patients and mixed acceptance among physicians. The satisfaction with the quality of the software used in the pilot project was low. Conclusions The overall aim to increase medication safety seems achievable through e-Medikation, but several limitations of the pilot project need to be solved before a national rollout. Based on the evaluation results and after redesign of e-Medikation, Austria is now planning a nationwide introduction of e-Medikation starting in 2015.
    Full-text · Article · Sep 2014 · International Journal of Medical Informatics
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    • "Au Canada, Vira et al. et Cornish et al. e ´valuent ces fréquences a ` 38,3 % et 54,6 % [8,9]. En Suède, Hellström et al. les estiment a ` 47 % [10]. Une e ´quipe américaine de médecins urgentistes montre que 87 % des listes de médicaments e ´tablies par le service des urgences contiennent au moins une erreur médicamenteuse chez les patients a ˆgés de 65 ans et plus [11]. "
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    ABSTRACT: Introduction Medication reconciliation (MR) is a formal clinical pharmacy activity. The aim of this research was to reorganize the process to make it more efficient. Method To address the issue of assessing such a complex process for inpatient admissions, standards for management information system were required. The assessment is established by comparing indicators before (period 1) and after reorganization (period 2) based on five performance and quality indicators. Results The new process is carried out by a 37-step flowchart. From February 2010 to March 2012, 4004 patients aged 65 or older hospitalized after their admission through the emergency department were included in this study. Reorganization has statistically improved the respective percentages of eligible inpatients medication lists reconciled, reconciled in a proactive way, and reconciled within 24 hours after hospital admission (P < 0.01 χ2 test). Discussion The search for efficiency in the organization of medication reconciliation showed a strong relationship with greater inpatient safety. There are two criteria to consider: 1) whether medication reconciliation can be fully integrated to the hospitals’ information system; 2) whether the pharmaceutical activities re-engineering can free up resources.
    Full-text · Article · Sep 2013 · Pharmacien Hospitalier et Clinicien
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    • "Au Canada, Vira et al. et Cornish et al. e ´valuent ces fréquences a ` 38,3 % et 54,6 % [8,9]. En Suède, Hellström et al. les estiment a ` 47 % [10]. Une e ´quipe américaine de médecins urgentistes montre que 87 % des listes de médicaments e ´tablies par le service des urgences contiennent au moins une erreur médicamenteuse chez les patients a ˆgés de 65 ans et plus [11]. "

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