A medication use history is an integral part of the hospital admission process, but errors in the history may result in failure to detect drug-related problems or lead to interrupted or inappropriate drug therapy during hospitalization, according to background information in the article. Earlier studies suggest that these errors are a potentially serious safety issue. The current study is designed to identify unintended discrepancies between physicians' admission medication orders and a comprehensive medication use history and the potential clinical significance of the discrepancy.
Patricia L. Cornish, B.Sc.Phm., of the University of Toronto, and colleagues screened medical charts from three months of admissions to the general internal medical clinics at an affiliated hospital and included patients in the study if they reported use of at least four medications and were either able to communicate or had a caregiver who could communicate for them. One hundred and fifty-one patients were included in the study. After allowing 48 hours for clarification of admission medication orders and corrections of problems in the normal course of care, a team member, a pharmacist or a trained pharmacy or medical student, would visit the patient and conduct a thorough history of their regular medication use, relying on a patient or caregiver interview, an inspection of prescription vials, and follow up with a community pharmacy.
Discrepancies between physicians' admission medication orders and the follow-up history were divided into four types of discrepancies: a drug omission, incorrect dose, incorrect frequency of dose and an incorrect drug. Each type of discrepancy was further judged to be of one of three classes of potential severity: class one discrepancies were unlikely to cause patient discomfort or clinical deterioration; class two discrepancies were those with the potential to cause moderate discomfort or clinical deterioration; and class three discrepancies had the potential to cause severe discomfort or clinical deterioration.
Eighty-one patients (53.6 percent) had at least one unintended discrepancy. "We identified 140 unintended discrepancies among these 81 patients," the authors write. "The most common error (46.4 percent) was omission of a regularly used medication. Most (61.4 percent) of the discrepancies were judged to have no potential to cause serious harm. However, 38.6 percent of the discrepancies had the potential to cause moderate to severe discomfort or clinical deterioration."
"The data presented herein suggest that the processes for recording medication histories on admission to the hospital are inadequate, potentially dangerous, and in need of improvement," the authors conclude. "To improve patient care and minimize the potential costs of preventable adverse drug events, the health care system should explore ways to improve the accuracy of the hospital admission medication history."
(Arch Intern Med. 2005; 165:424-429. Available post-embargo at www.archinternmed.com.)
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Journal
Archives of Internal Medicine