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Medication reconciliation at admission and discharge: an analysis of prevalence and associated risk factors.
Int J Clin Pract 2015; 69(11):1268-74IJ

Abstract

INTRODUCTION

Medication errors are frequent at care transition points and can have serious repercussions. Study objectives were to examine the frequency/type of reconciliation errors at hospital admission and discharge and to report on the drugs involved, associated risk factors and potential to cause harm in a healthcare setting with comprehensive digital health records.

MATERIAL AND METHODS

A prospective observational 2-year study was conducted in the Internal Medicine Department of a regional hospital. The best possible medication history was obtained from different sources by clinical pharmacists and compared with prescriptions at admission and discharge. The frequency and type of reconciliation errors were studied at admission and discharge, evaluating risk factors for their occurrence and their potential to cause harm.

RESULTS

The study included 814 patients (mean age: 80.2 years). At least one reconciliation error was detected in 525 (64.5%) patients at admission, with a mean of 2.2 ± 1.3 errors per patient and in 235 (32.4%) patients at discharge. Drug omission was the most frequent reconciliation error (73.6% at admission and 71.4% at discharge); 39% of errors at admission and 51% at discharge had potential to cause moderate or severe harm. The risk of error at admission was higher with more pre-admission drugs (p < 0.001) and, among patients with reconciliation errors, the number of errors was significantly higher in those receiving more drugs pre-admission or with more comorbidities. The risk at discharge was higher in patients with more drugs prescribed at discharge (p = 0.04) and in those with a longer hospital stay (p = 0.03).

CONCLUSIONS

Medication reconciliation procedures are required to minimise medication discrepancies and enhance patient safety. Integration of patient health records across care levels is necessary but not sufficient to prevent errors.

Authors+Show Affiliations

Hospital Pharmacy Service, Biohealth Research Institute of Granada, University Hospital Complex, Granada, Spain.Internal Medicine Service, University Hospital Complex, Granada, Spain.Hospital Pharmacy Service, Biohealth Research Institute of Granada, University Hospital Complex, Granada, Spain.Hospital Pharmacy Service, Biohealth Research Institute of Granada, University Hospital Complex, Granada, Spain. Pharmaceutical Care Research Group, University of Granada, Granada, Spain.Hospital Pharmacy Service, Biohealth Research Institute of Granada, University Hospital Complex, Granada, Spain.CIBER-EHD, Department of Pharmacology, ibs. Granada, Center for Biomedical Research (CIBM), University of Granada, Granada, Spain.

Pub Type(s)

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

Language

eng

PubMed ID

26202091

Citation

Belda-Rustarazo, S, et al. "Medication Reconciliation at Admission and Discharge: an Analysis of Prevalence and Associated Risk Factors." International Journal of Clinical Practice, vol. 69, no. 11, 2015, pp. 1268-74.
Belda-Rustarazo S, Cantero-Hinojosa J, Salmeron-García A, et al. Medication reconciliation at admission and discharge: an analysis of prevalence and associated risk factors. Int J Clin Pract. 2015;69(11):1268-74.
Belda-Rustarazo, S., Cantero-Hinojosa, J., Salmeron-García, A., González-García, L., Cabeza-Barrera, J., & Galvez, J. (2015). Medication reconciliation at admission and discharge: an analysis of prevalence and associated risk factors. International Journal of Clinical Practice, 69(11), pp. 1268-74. doi:10.1111/ijcp.12701.
Belda-Rustarazo S, et al. Medication Reconciliation at Admission and Discharge: an Analysis of Prevalence and Associated Risk Factors. Int J Clin Pract. 2015;69(11):1268-74. PubMed PMID: 26202091.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Medication reconciliation at admission and discharge: an analysis of prevalence and associated risk factors. AU - Belda-Rustarazo,S, AU - Cantero-Hinojosa,J, AU - Salmeron-García,A, AU - González-García,L, AU - Cabeza-Barrera,J, AU - Galvez,J, Y1 - 2015/07/22/ PY - 2015/7/24/entrez PY - 2015/7/24/pubmed PY - 2016/12/15/medline SP - 1268 EP - 74 JF - International journal of clinical practice JO - Int. J. Clin. Pract. VL - 69 IS - 11 N2 - INTRODUCTION: Medication errors are frequent at care transition points and can have serious repercussions. Study objectives were to examine the frequency/type of reconciliation errors at hospital admission and discharge and to report on the drugs involved, associated risk factors and potential to cause harm in a healthcare setting with comprehensive digital health records. MATERIAL AND METHODS: A prospective observational 2-year study was conducted in the Internal Medicine Department of a regional hospital. The best possible medication history was obtained from different sources by clinical pharmacists and compared with prescriptions at admission and discharge. The frequency and type of reconciliation errors were studied at admission and discharge, evaluating risk factors for their occurrence and their potential to cause harm. RESULTS: The study included 814 patients (mean age: 80.2 years). At least one reconciliation error was detected in 525 (64.5%) patients at admission, with a mean of 2.2 ± 1.3 errors per patient and in 235 (32.4%) patients at discharge. Drug omission was the most frequent reconciliation error (73.6% at admission and 71.4% at discharge); 39% of errors at admission and 51% at discharge had potential to cause moderate or severe harm. The risk of error at admission was higher with more pre-admission drugs (p < 0.001) and, among patients with reconciliation errors, the number of errors was significantly higher in those receiving more drugs pre-admission or with more comorbidities. The risk at discharge was higher in patients with more drugs prescribed at discharge (p = 0.04) and in those with a longer hospital stay (p = 0.03). CONCLUSIONS: Medication reconciliation procedures are required to minimise medication discrepancies and enhance patient safety. Integration of patient health records across care levels is necessary but not sufficient to prevent errors. SN - 1742-1241 UR - https://www.unboundmedicine.com/medline/citation/26202091/Medication_reconciliation_at_admission_and_discharge:_an_analysis_of_prevalence_and_associated_risk_factors_ L2 - https://doi.org/10.1111/ijcp.12701 DB - PRIME DP - Unbound Medicine ER -