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Reconcilable differences: correcting medication errors at hospital admission and discharge.
Qual Saf Health Care 2006; 15(2):122-6QS

Abstract

BACKGROUND

Medication errors at the time of hospital admission and discharge are common and can lead to preventable adverse drug events. The objective of this study was to describe the potential impact of a medication reconciliation process to identify and rectify medication errors at the time of hospital admission and discharge.

METHODS

Sixty randomly selected patients were prospectively enrolled at the time of admission to a Canadian community hospital. At admission, patients' medication orders were compared with pre-admission medication use based on medication vials and interviews with patients, caregivers, and/or outpatient healthcare providers. At discharge, pre-admission and in-patient medications were compared with discharge orders and written instructions. All variances were discussed with the prescribing physician and classified as intended or unintended; unintended variances were considered to be medication errors. An internist classified the clinical importance of each unintended variance.

RESULTS

Overall, 60% (95% CI 48 to 72) of patients had at least one unintended variance and 18% (95% CI 9 to 28) had at least one clinically important unintended variance. None of the variances had been detected by usual clinical practice before reconciliation was conducted. Of the 20 clinically important variances, 75% (95% CI 56 to 94) were intercepted by medication reconciliation before patients were harmed.

DISCUSSION

Unintended medication variances at the time of hospital admission and discharge are common and clinically important. The medication reconciliation process identified and addressed most of these unintended variances before harm occurred. In this small study, medication reconciliation was a useful method for identifying and rectifying medication errors at times of transition. Reconciliation warrants broader evaluation.

Authors+Show Affiliations

Markham Stouffville Hospital, Markham, ON, Canada L3R 7E8; tasnim.vira@utoronto.caNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16585113

Citation

Vira, T, et al. "Reconcilable Differences: Correcting Medication Errors at Hospital Admission and Discharge." Quality & Safety in Health Care, vol. 15, no. 2, 2006, pp. 122-6.
Vira T, Colquhoun M, Etchells E. Reconcilable differences: correcting medication errors at hospital admission and discharge. Qual Saf Health Care. 2006;15(2):122-6.
Vira, T., Colquhoun, M., & Etchells, E. (2006). Reconcilable differences: correcting medication errors at hospital admission and discharge. Quality & Safety in Health Care, 15(2), pp. 122-6.
Vira T, Colquhoun M, Etchells E. Reconcilable Differences: Correcting Medication Errors at Hospital Admission and Discharge. Qual Saf Health Care. 2006;15(2):122-6. PubMed PMID: 16585113.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reconcilable differences: correcting medication errors at hospital admission and discharge. AU - Vira,T, AU - Colquhoun,M, AU - Etchells,E, PY - 2006/4/6/pubmed PY - 2006/5/6/medline PY - 2006/4/6/entrez SP - 122 EP - 6 JF - Quality & safety in health care JO - Qual Saf Health Care VL - 15 IS - 2 N2 - BACKGROUND: Medication errors at the time of hospital admission and discharge are common and can lead to preventable adverse drug events. The objective of this study was to describe the potential impact of a medication reconciliation process to identify and rectify medication errors at the time of hospital admission and discharge. METHODS: Sixty randomly selected patients were prospectively enrolled at the time of admission to a Canadian community hospital. At admission, patients' medication orders were compared with pre-admission medication use based on medication vials and interviews with patients, caregivers, and/or outpatient healthcare providers. At discharge, pre-admission and in-patient medications were compared with discharge orders and written instructions. All variances were discussed with the prescribing physician and classified as intended or unintended; unintended variances were considered to be medication errors. An internist classified the clinical importance of each unintended variance. RESULTS: Overall, 60% (95% CI 48 to 72) of patients had at least one unintended variance and 18% (95% CI 9 to 28) had at least one clinically important unintended variance. None of the variances had been detected by usual clinical practice before reconciliation was conducted. Of the 20 clinically important variances, 75% (95% CI 56 to 94) were intercepted by medication reconciliation before patients were harmed. DISCUSSION: Unintended medication variances at the time of hospital admission and discharge are common and clinically important. The medication reconciliation process identified and addressed most of these unintended variances before harm occurred. In this small study, medication reconciliation was a useful method for identifying and rectifying medication errors at times of transition. Reconciliation warrants broader evaluation. SN - 1475-3901 UR - https://www.unboundmedicine.com/medline/citation/16585113/Reconcilable_differences:_correcting_medication_errors_at_hospital_admission_and_discharge_ L2 - http://qhc.bmj.com/cgi/pmidlookup?view=long&pmid=16585113 DB - PRIME DP - Unbound Medicine ER -