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Effect of Patient- and Medication-Related Factors on Inpatient Medication Reconciliation Errors

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Journal of General Internal Medicine Aims and scope Submit manuscript

An Erratum to this article was published on 27 July 2012

ABSTRACT

Background

Little research has examined the incidence, clinical relevance, and predictors of medication reconciliation errors at hospital admission and discharge.

Objective

To identify patient- and medication-related factors that contribute to pre-admission medication list (PAML) errors and admission order errors, and to test whether such errors persist in the discharge medication list.

Design, Participants

We conducted a cross-sectional analysis of 423 adults with acute coronary syndromes or acute decompensated heart failure admitted to two academic hospitals who received pharmacist-assisted medication reconciliation during the Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL–CVD) Study.

Main Measures

Pharmacists assessed the number of total and clinically relevant errors in the PAML and admission and discharge medication orders. We used negative binomial regression and report incidence rate ratios (IRR) of predictors of reconciliation errors.

Key Results

On admission, 174 of 413 patients (42%) had ≥1 PAML error, and 73 (18%) had ≥1 clinically relevant PAML error. At discharge, 158 of 405 patients (39%) had ≥1 discharge medication error, and 126 (31%) had ≥1 clinically relevant discharge medication error. Clinically relevant PAML errors were associated with older age (IRR = 1.46; 95% CI, 1.00– 2.12) and number of pre-admission medications (IRR = 1.17; 95% CI, 1.10–1.25), and were less likely when a recent medication list was present in the electronic medical record (EMR) (IRR = 0.54; 95% CI, 0.30–0.96). Clinically relevant admission order errors were also associated with older age and number of pre-admission medications. Clinically relevant discharge medication errors were more likely for every PAML error (IRR = 1.31; 95% CI, 1.19–1.45) and number of medications changed prior to discharge (IRR = 1.06; 95% CI, 1.01–1.11).

Conclusions

Medication reconciliation errors are common at hospital admission and discharge. Errors in preadmission medication histories are associated with older age and number of medications and lead to more discharge reconciliation errors. A recent medication list in the EMR is protective against medication reconciliation errors.

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REFERENCES

  1. Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R, Etchells EE. Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. Can Med Assoc J. 2005;173(5):510–5.

    Article  Google Scholar 

  2. Boockvar KS, Liu S, Goldstein N, Nebeker J, Siu A, Fried T. Prescribing discrepancies likely to cause adverse drug events after patient transfer. Qual Saf Health Care. 2009;18(1):32–6.

    Article  PubMed  CAS  Google Scholar 

  3. Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;165(4):424–9.

    Article  PubMed  Google Scholar 

  4. Wong JD, Bajcar JM, Wong GG, et al. Medication reconciliation at hospital discharge: evaluating discrepancies. Ann Pharmacother. 2008;42(10):1373–9.

    PubMed  Google Scholar 

  5. Rogers G, Alper E, Brunelle D, et al. Reconciling medications at admission: safe practice recommendations and implementation strategies. Jt Comm J Qual Patient Saf. 2006;32(1):37–50.

    PubMed  Google Scholar 

  6. Commission J. Approved: 2010 National Patient Safety Goals. Joint Commission Perspectives. 2009;29(10):1–31.

    Google Scholar 

  7. Girard TD, Jackson JC, Pandharipande PP, et al. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med. 2010;38(7):1513–20.

    Article  PubMed  Google Scholar 

  8. Institute for Healthcare Improvement. Medication reconciliation review. 2007. (Accessed January 19, 2012, at http://www.ihi.org/knowledge/Pages/Tools/MedicationReconciliationReview.aspx.)

  9. Marvanova M, Roumie CL, Eden SK, Cawthon C, Schnipper JL, Kripalani S. Health literacy and medication understanding among hospitalized adults. Journal of Hospital Medicine (accepted) 2011.

  10. Murphy CR, Corbett CL, Setter SM, Dupler A. Exploring the concept of medication discrepancy within the context of patient safety to improve population health. ANS Adv Nurs Sci. 2009;32(4):338–50.

    PubMed  Google Scholar 

  11. Climente-Marti M, Garcia-Manon ER, Artero-Mora A, Jimenez-Torres NV. Potential risk of medication discrepancies and reconciliation errors at admission and discharge from an inpatient medical service. Ann Pharmacother. 2010;44(11):1747–54.

    Article  PubMed  Google Scholar 

  12. Pippins JR, Gandhi TK, Hamann C, et al. Classifying and predicting errors of inpatient medication reconciliation. J Gen Intern Med. 2008;23(9):1414–22.

    Article  PubMed  Google Scholar 

  13. Moore C, Wisnivesky J, Williams S, McGinn T. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med. 2003;186:46–51.

    Google Scholar 

  14. Gleason KM, McDaniel MR, Feinglass J, et al. Results of the Medications at Transitions and Clinical Handoffs (MATCH) study: an analysis of medication reconciliation errors and risk factors at hospital admission. J Gen Intern Med. 2010;25(5):441–7.

    Article  PubMed  Google Scholar 

  15. Unroe KT, Pfeiffenberger T, Riegelhaupt S, Jastrzembski J, Lokhnygina Y, Colon-Emeric C. Inpatient medication reconciliation at admission and discharge: A retrospective cohort study of age and other risk factors for medication discrepancies. Am J Geriatr Pharmacother. 2010;8(2):115–26.

    Article  PubMed  Google Scholar 

  16. Schnipper JL, Roumie CL, Cawthon C, et al. The rationale and design of the Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL–CVD) study. Circulation: Cardiovascular Quality & Outcomes 2010;3212–9.

  17. Borson S, Scanlan JM, Watanabe J, Tu SP, Lessig M. Simplifying detection of cognitive impairment: comparison of the Mini-Cog and Mini-Mental State Examination in a multiethnic sample. J Am Geriatr Soc. 2005;53(5):871–4.

    Article  PubMed  Google Scholar 

  18. Borson S, Scanlan JM, Chen P, Ganguli M. The Mini-Cog as a screen for dementia: validation in a population-based sample. J Am Geriatr Soc. 2003;51(10):1451–4.

    Article  PubMed  Google Scholar 

  19. Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a cognitive 'vital signs' measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry. 2000;15(11):1021–7.

    Article  PubMed  CAS  Google Scholar 

  20. Baker DW, Williams MV, Parker RM, Gazmararian JA, Nurss JR. Development of a brief test to measure functional health literacy. Patient Educ Couns. 1999;38:33–42.

    Article  PubMed  CAS  Google Scholar 

  21. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.

    Article  PubMed  CAS  Google Scholar 

  22. Lessard S, DeYoung J, Vazzana N. Medication discrepancies affecting senior patients at hospital admission. Am J Health Syst Pharm. 2006;63(8):740–3.

    Article  PubMed  Google Scholar 

  23. 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.

    Article  PubMed  CAS  Google Scholar 

  24. Gleason KM, Groszek JM, Sullivan C, Rooney D, Barnard C, Noskin GA. Reconciliation of discrepancies in medication histories and admission orders of newly hospitalized patients. Am J Health Syst Pharm. 2004;61(16):1689–95.

    PubMed  Google Scholar 

  25. Gleason KM, Groszek JM, Sullivan C, Rooney D, Barnard C, Noskin GA. Reconciliation of discrepancies in medication histories and admission orders of newly hospitalized patients. Am J Health Syst Pharm. 2004;61(16):1689–95.

    PubMed  Google Scholar 

  26. Herrero-Herrero JI, Garcia-Aparicio J. Medication discrepancies at discharge from an internal medicine service. Eur J Intern Med. 2011;22(1):43–8.

    Article  PubMed  Google Scholar 

  27. Cumbler E, Carter J, Kutner J. Failure at the transition of care: challenges in the discharge of the vulnerable elderly patient. J Hosp Med. 2008;3(4):349–52.

    Article  PubMed  Google Scholar 

  28. Coleman EA. Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs. J Am Geriatr Soc. 2003;51(4):549–55.

    Article  PubMed  Google Scholar 

  29. Hasan O, Meltzer DO, Shaykevich SA, et al. Hospital Readmission in General Medicine Patients: A Prediction Model. J Gen Intern Med. 2010;25:211–219

  30. Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009;150(3):178–87.

    PubMed  Google Scholar 

  31. Walker PC, Bernstein SJ, Jones JN, et al. Impact of a pharmacist-facilitated hospital discharge program: a quasi-experimental study. Arch Intern Med. 2009;169(21):2003–10.

    Article  PubMed  Google Scholar 

  32. Coleman EA, Parry C, Chalmers S, Min S. The Care Transitions Intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166(17):1822–8.

    Article  PubMed  Google Scholar 

  33. Project BOOST. Society of Hospital Medicine, 2009. (Accessed March 30, 2011, at http://www.hospitalmedicine.org/AM/Template.cfm?Section=Home&TEMPLATE=/CM/HTMLDisplay.cfm&CONTENTID=27659.)

  34. Coleman EA, Smith JD, Raha D, Min SJ. Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005;165(16):1842–7.

    Article  PubMed  Google Scholar 

  35. Poon EG, Blumenfeld B, Hamann C, et al. Design and implementation of an application and associated services to support interdisciplinary medication reconciliation efforts at an integrated healthcare delivery network. J Am Med Inform Assoc. 2006;13(6):581–92.

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank CL Leak, A Munjal, E Swain, KJ Niesner, and C Bass. Grant support: National Heart, Lung and Blood Institute R01 HL089755 to Drs. Kripalani and Schnipper. The funding agency was not involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Dr. Salanitro had full access to all study data and takes responsibility for data integrity and data analysis accuracy. Presented at the Society of General Internal Medicine 34th Annual Meeting in Phoenix, May 6, 2011.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Dr. Kripalani is a consultant to and holds equity in PictureRx, LLC.

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Correspondence to Amanda H. Salanitro MD, MS, MSPH.

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Salanitro, A.H., Osborn, C.Y., Schnipper, J.L. et al. Effect of Patient- and Medication-Related Factors on Inpatient Medication Reconciliation Errors. J GEN INTERN MED 27, 924–932 (2012). https://doi.org/10.1007/s11606-012-2003-y

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  • DOI: https://doi.org/10.1007/s11606-012-2003-y

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