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

https://doi.org/10.1016/j.amjopharm.2010.04.002Get rights and content

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 high potential to identify clinically important discrepancies for all patients.

References (31)

  • DW Bates et al.

    Incidence of adverse drug events and potential adverse drug events. Implications for prevention

    JAMA

    (1995)
  • CA Bond et al.

    Clinical pharmacy services, hospital pharmacy staffing, and medication errors in United States hospitals

    Pharmacotherapy

    (2002)
  • DC Classen et al.

    Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality

    JAMA

    (1997)
  • PL Cornish et al.

    Unintended medication discrepancies at the time of hospital admission

    Arch Intern Med

    (2005)
  • T Vira et al.

    Reconcilable differences: Correcting medication errors at hospital admission and discharge

    Qual Saf Health Care

    (2006)
  • JR Pippins et al.

    Classifying and predicting errors of inpatient medication reconciliation

    J Gen Intern Med

    (2008)
  • P Varkey et al.

    Multidisciplinary approach to inpatient medication reconciliation in an academic setting

    Am J Health Syst Pharm

    (2007)
  • S Lessard et al.

    Medication discrepancies affecting senior patients at hospital admission

    Am J Health Syst Pharm

    (2006)
  • AJ Forster et al.

    Adverse drug events occurring following hospital discharge

    J Gen Intern Med

    (2005)
  • EA Coleman et al.

    Posthospital medication discrepancies: Prevalence and contributing factors

    Arch Intern Med

    (2005)
  • Sentinel Event Alert: Using medication reconciliation to prevent errors

  • Approved: Will not score medication reconciliation in 2009. The Joint Commission plans to review, refine NPSG 8 for 2010

    Joint Commission Perspectives

    (2009)
  • JL Schnipper et al.

    Effect of an electronic medication reconciliation application and process redesign on potential adverse drug events: A cluster-randomized trial

    Arch Intern Med

    (2009)
  • BJ Clay et al.

    Results of a medication reconciliation survey from the 2006 Society of Hospital Medicine national meeting

    J Hosp Med

    (2008)
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