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.
Similar content being viewed by others
REFERENCES
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.
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.
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.
Wong JD, Bajcar JM, Wong GG, et al. Medication reconciliation at hospital discharge: evaluating discrepancies. Ann Pharmacother. 2008;42(10):1373–9.
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.
Commission J. Approved: 2010 National Patient Safety Goals. Joint Commission Perspectives. 2009;29(10):1–31.
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.
Institute for Healthcare Improvement. Medication reconciliation review. 2007. (Accessed January 19, 2012, at http://www.ihi.org/knowledge/Pages/Tools/MedicationReconciliationReview.aspx.)
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Lessard S, DeYoung J, Vazzana N. Medication discrepancies affecting senior patients at hospital admission. Am J Health Syst Pharm. 2006;63(8):740–3.
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.
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.
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.
Herrero-Herrero JI, Garcia-Aparicio J. Medication discrepancies at discharge from an internal medicine service. Eur J Intern Med. 2011;22(1):43–8.
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.
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.
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
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.
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.
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.
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.)
Coleman EA, Smith JD, Raha D, Min SJ. Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005;165(16):1842–7.
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.
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-012-2003-y