Classifying and predicting errors of inpatient medication reconciliation.

Area of Science:

• Pharmacovigilance
• Patient Safety
• Health Services Research

Background:

• Medication reconciliation failures during care transitions cause patient harm.
• Predictors and occurrence patterns of unintentional medication discrepancies are poorly understood.

Purpose of the Study:

• Determine reasons for medication discrepancies.
• Identify timing and predictors of potentially harmful medication discrepancies.

Main Methods:

• Prospective observational study of general medical patients.
• Comparison of pharmacist-led medication histories against medical team records and orders.
• Adjudication of discrepancies by blinded physician teams to identify potential adverse drug events (PADEs).

Main Results:

• 1.4 potentially harmful unintentional medication discrepancies per patient identified.
• 72% of discrepancies resulted from errors in pre-admission medication history taking.
• 75% of potential adverse drug events occurred at discharge.

Conclusions:

• Inaccurate medication histories are a primary source of unintentional discrepancies.
• Interventions should focus on improving medication history accuracy and discharge reconciliation.
• Identifying high-risk patients is crucial for targeted medication safety interventions.