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Errors in medication history at hospital admission: prevalence and predicting factors
Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences. (eHälsoinstitutet)
2012 (English)In: BMC Clinical Pharmacology, ISSN 1472-6904, Vol. 12, Article ID: 9- p.Article in journal (Refereed) Published
Abstract [en]

Background: An accurate medication list at hospital admission is essential for the evaluation and further treatment of patients. The objective of this study was to describe the frequency, type and predictors of errors in medication history, and to evaluate the extent to which standard care corrects these errors.

Methods:A descriptive study was carried out in two medical wards in a Swedish hospital using Lund Integrated Medicines Management (LIMM)-based medication reconciliation. A clinical pharmacist identified each patient's most accurate pre-admission medication list by conducting a medication reconciliation process shortly after admission. This list was then compared with the patient's medication list in the hospital medical records. Addition or withdrawal of a drug or changes to the dose or dosage form in the hospital medication list were considered medication discrepancies. Medication discrepancies for which no clinical reason could be identified (unintentional changes) were considered medication history errors.

Results: The final study population comprised 670 of 818 eligible patients. At least one medication history error was identified by pharmacists conducting medication reconciliations for 313 of these patients (47%; 95% CI 43-51%). The most common medication error was an omitted drug, followed by a wrong dose. Multivariate logistic regression analysis showed that a higher number of drugs at admission (odds ratio [OR] per 1 drug increase = 1.10; 95% CI 1.06 - 1.14; p<0.0001) and the patient living in their own home without any care services (OR1.58; 95% CI 1.02 - 2.45; p = 0.042) were predictors for medication history errors at admission. The results further indicated that standard care by non-pharmacist ward staff had partly corrected the errors in affected patients by four days after admission, but a considerable proportion of the errors made in the initial medication history at admission remained undetected by standard care (OR for medication errors detected by pharmacists' medication reconciliation carried out on days 4 - 11 compared to days 0 - 1 = 0.52; 95% CI 0.30 - 0.91; p = 0.021).

Conclusions: Clinical pharmacists conducting LIMM-based medication reconciliations have a high potential for correcting errors in medication history for all patients. In an older Swedish population, those prescribed many drugs seem to benefit most from admission medication reconciliation.

Place, publisher, year, edition, pages
2012. Vol. 12, Article ID: 9- p.
Keyword [en]
Clinical pharmacy services, pharmacist, medication, drug, medicine, medication reconciliation, medication errors, elderly, inpatients, hospitalisation, multiprofessional, patient care team, continuity of patient care
Keyword [sv]
KLinisk farmaci, farmaceut, läkemedel, läkemedelsavstämning, läkemedelsfel, äldre, sjukhus, vårdteam, kontinuitet i vården
National Category
Social and Clinical Pharmacy
Research subject
Natural Science, Biomedical Sciences
Identifiers
URN: urn:nbn:se:lnu:diva-18295DOI: 10.1186/1472-6904-12-9Scopus ID: 2-s2.0-84859184890OAI: oai:DiVA.org:lnu-18295DiVA: diva2:514902
Projects
Läkemedelsgenomgångar och läkemedelsavstämning - LIMM-modellen
Available from: 2012-04-23 Created: 2012-04-11 Last updated: 2018-01-12Bibliographically approved
In thesis
1. Clinical pharmacy services within a multiprofessional healthcare team
Open this publication in new window or tab >>Clinical pharmacy services within a multiprofessional healthcare team
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The purpose of drug treatment is to reduce morbidity and mortality, and to improve health-related quality of life. However, there are frequent problems associated with drug treatment, especially among the elderly. The aim of this thesis was to investigate the impact of clinical pharmacy services within a multiprofessional healthcare team on quality and safety of patients’ drug therapy, and to study the frequency and nature of medication history errors on admission to hospital.

Methods: A model for clinical pharmacy services within a multiprofessional healthcare team (the Lund Integrated Medicines Management model, LIMM) was introduced in three hospital wards. On admission of patients to hospital, clinical pharmacists conducted medication reconciliation (i.e. identified the most accurate list of a patient’s current medications) to identify any errors in the hospital medication list. To identify, solve and prevent any other drug-related problems, the clinical pharmacists interviewed patients and performed medication reviews and monitoring of drug therapy. Drug-related problems were discussed within the multiprofessional team and the physicians adjusted the drug therapy as appropriate.

Results: On admission to hospital, drug-related problems, such as low adherence to drug therapy and concerns about treatment, were identified. Different statistical approaches to present results from ordinal data on adherence and beliefs about medicines were suggested. Approximately half of the patients were affected by errors in the medication history at admission to hospital; patients who had many prescription drugs had a higher risk for errors. Medication reconciliation and review reduced the number of inappropriate medications and reduced drug-related hospital revisits. No impact on all-cause hospital revisits was demonstrated.

Conclusion: Patients admitted to hospital are at high risk for being affected by medication history errors and there is a high potential to improve their drug therapy. By reducing medication history errors and improving medication appropriateness, clinical pharmacy services within a multiprofessional healthcare team improve the quality and safety of patients’ drug therapy. The impact of routine implementation of medication reconciliation and review on healthcare visits will need further evaluation; the results from this thesis suggest that drug-related hospital revisits could be reduced.

Place, publisher, year, edition, pages
Växjö, Kalmar: Linnaeus University Press, 2012. 63 p.
Series
Linnaeus University Dissertations, 84/2012
Keyword
Clinical pharmacy services, pharmacist, medication review, medication reconciliation, medication errors, drug-related problems, inappropriate prescribing, elderly, inpatients, patient readmissions, hospitalisation, multiprofessional, patient care team, continuity of patient care, Klinisk farmaci, farmaceut, läkemedelsgenomgång, läkemedelsavstämning, läkemedelsfel, läkemedelsrelaterade problem, olämpliga läkemedel, äldre, återinläggning, sjukhusinläggning, multiprofessionell, vårdteam, kontinuitet i vården
National Category
Social and Clinical Pharmacy
Research subject
Natural Science, Biomedical Sciences
Identifiers
urn:nbn:se:lnu:diva-18293 (URN)978-91-86983-47-5 (ISBN)
Public defence
2012-05-16, N2007, Västergård, Smålandsgatan 26E, Kalmar, 13:00 (Swedish)
Opponent
Supervisors
Projects
Läkemedelsgenomgångar och läkemedelsavstämning - LIMM-modellen
Available from: 2012-04-12 Created: 2012-04-11 Last updated: 2018-01-12Bibliographically approved

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