Omitted and unjustified medications in the discharge summary

Intensive Care Unit, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland.
Quality and Safety in Health Care (Impact Factor: 2.16). 06/2009; 18(3):205-8. DOI: 10.1136/qshc.2007.024588
Source: PubMed


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.

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Available from: Bernard Cerutti, Nov 12, 2015
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    • "Comprehensive medication information, including explanations of any medication changes during hospitalisation, are important to communicate to general practitioners (GPs) to facilitate their counselling of patients and to prevent medication errors after discharge (Karapinar et al. 2010). Despite the importance of an accurate list of medications at discharge, several studies have shown Research that medication lists in discharge summaries are often incomplete, inaccurate or inadequate (Wilson et al. 2001; McMillan, Allan & Black 2006; Glintborg, Andersen & Black 2007; Perren et al. 2009; Viktil et al. 2012). Many hospitals have introduced electronic systems to improve the information communicated in discharge summaries. "
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    ABSTRACT: Complete, accurate and timely hospital discharge summaries are important for continuity of care. The aim of this study was to evaluate the effectiveness of an electronic discharge summary system in improving the medication information provided compared to the information in paper discharge summaries. We conducted a retrospective audit of 199 paper and 200 electronic discharge summaries from a 350-bed teaching hospital in Sydney, Australia. The completeness of medication information, and whether medication changes during the admission were explained, were assessed. Further, the likelihood of any incomplete information having an impact on continuity of care was assessed. There were 1352 and 1771 medication orders assessed in paper and electronic discharge summaries, respectively. Of these, 90.9% and 93.4% were complete in paper and electronic discharge summaries, respectively. The dose (OR 25.24, 95% CI: 3.41-186.9) and route (OR 8.65, 95% CI: 3.46-21.59) fields of medication orders, were more likely to be complete in electronic as compared with paper discharge summaries. There was no difference for drug frequency (OR 1.09, 95% CI: 0.77-1.55). There was no significant improvement in the proportion of incomplete medication orders rated as unclear and likely to impede continuity of care in paper compared with electronic discharge summaries (7.3% vs. 6.5%). Of changes to medication regimen, only medication additions were more likely to be explained in the electronic (n=253, 37.2%) compared to paper (n=104, 14.3%) discharge summaries (OR 3.14; 95% CI: 2.20-4.18). In summary, electronic discharge summaries offer some improvements over paper discharge summaries in terms of the quality of medication information documented. However, explanations of changes to medication regimens remained low, despite this being crucial information. Future efforts should focus on including the rationale for changes to medication regimens in discharge summaries.
    Full-text · Article · Jul 2014 · The HIM journal
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    • "Often these problems are due to miscommunication regarding the continuation/discontinuation of medications on hospital discharge [5]. The interface between hospital and the community care is a high risk area for medication misadventure [5-7]. "
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    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.
    Full-text · Article · Dec 2012 · BMC Health Services Research
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    • "The results from the quality assessment highlight areas for improvement in PGY-1 discharge summaries, specifically the accurate reporting of current and modified medications, along with the rationale for changes made. Adverse drug events account for 72% of all adverse events post-discharge, and half of these are preventable [4]. Of the discharge summaries in our sample for which a discharge medication list was present, almost 40% contained inaccuracies in the list of discharge medications. "
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    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.
    Full-text · Article · Aug 2012 · BMC Medical Education
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