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Errors in medication history at hospital admission prevalence and predicting factors.doc

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Errors in medication history at hospital admission prevalence and predicting factors

Hellstr?metal.BMCClinicalPharmacology2012,12:9 /1472-6904/12/9 RESEARCH ARTICLE OpenAccess Errorsinmedicationhistoryathospitaladmission: prevalenceandpredictingfactors LinaMHellstr?m1*,?saBondesson2,PeterH?glund3andTommyEriksson3 Abstract Background:Anaccuratemedicationlistathospitaladmissionisessentialfortheevaluationandfurthertreatment ofpatients.Theobjectiveofthisstudywastodescribethefrequency,typeandpredictorsoferrorsinmedication history,andtoevaluatetheextenttowhichstandardcarecorrectstheseerrors. Methods:AdescriptivestudywascarriedoutintwomedicalwardsinaSwedishhospitalusingLundIntegrated MedicinesManagement(LIMM)-basedmedicationreconciliation.Aclinicalpharmacistidentifiedeachpatient’s mostaccuratepre-admissionmedicationlistbyconductingamedicationreconciliationprocessshortlyafter admission.Thislistwasthencomparedwiththepatient’smedicationlistinthehospitalmedicalrecords.Addition orwithdrawalofadrugorchangestothedoseordosageforminthehospitalmedicationlistwereconsidered medicationdiscrepancies.Medicationdiscrepanciesforwhichnoclinicalreasoncouldbeidentified(unintentional changes)wereconsideredmedicationhistoryerrors. Results:Thefinalstudypopulationcomprised670of818eligiblepatients.Atleastonemedicationhistoryerror wasidentifiedbypharmacistsconductingmedicationreconciliationsfor313ofthesepatients(47%;95%CI43- 51%).Themostcommonmedicationerrorwasanomitteddrug,followedbyawrongdose.Multivariatelogistic regressionanalysisshowedthatahighernumberofdrugsatadmission(oddsratio[OR]per1drugincrease= 1.10;95%CI1.06-1.14;p0.0001)andthepatientlivingintheirownhomewithoutanycareservices(OR=1.58; 95%CI1.02-2.45;p=0.042)werepredictorsformedicationhistoryerrorsatadmission.Theresultsfurtherindicated thatstandardcarebynon-pharmacistwardstaffhadpartlycorrectedtheerrorsinaffectedpatientsbyfourdays afteradmission,butaconsiderableproportionoftheerrorsmadeintheinitialmedicationhistoryatadmission remainedundetectedbystandardcare(ORformedicationerrorsdetectedbypharmacists’medication reconci