Detailed, up-to-date medication lists help prevent errors
Research Activities, September 2010, No. 361
Primary care physicians should help their patients develop and maintain medication lists and encourage a review at every health encounter, suggests a new study. After pharmacists reviewed the records of and conducted interviews with 651 adult general medicine inpatients at a Chicago hospital, they found that more than a third of patients were switched to different medications by their physicians during the first 48 hours of hospitalization due to unexplained medication discrepancies. For 85 percent of these patients, the source of errors occurred in their medication histories, which then carried through to their inpatient orders. Omission of a medication was the most frequent error (48.9 percent), followed by different dose (30.4 percent) and different frequency (11 percent).
Four of the medication errors could have resulted in longer hospital stays if they were not caught, 32 could have caused temporary harm, and 162 could have required increased monitoring. Medications most commonly involved in errors were cardiovascular drugs, antidepressants, gastrointestinal agents, neurological agents, and diabetes drugs.
The authors suggest that since most of the detected errors happened when clinicians were obtaining and recording patients' medication histories, a multidisciplinary approach toward medication reconciliation involving physicians, nurses, and pharmacists may help ensure that accurate medication histories are available. Closer to home, primary care physicians should encourage their patients, especially older individuals who take many medicines, to keep their medication lists current and carry them with them at all times in the event they face an unexpected hospitalization or emergency room or doctor's visit. This study was funded in part by the Agency for Healthcare Research and Quality (HS13903).
See "Results of the Medications at Transitions and Clinical Handoffs (MATCH) Study: An analysis of medication reconciliation errors and risk factors at hospital admission," by Kristine M. Gleason, R.Ph., Molly R. McDaniel, Pharm.D., Joseph Feinglass, Ph.D., and others in the May 2010 Journal of General and Internal Medicine 25(5), pp. 441-447.