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Medication reconciliation at hospital discharge: evaluating discrepancies
Jacqueline D Wong1, Jana M Bajcar, Gary G Wong
1Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
The Annals of Pharmacotherapy
|September 11, 2008
Summary
Hospital discharge medication discrepancies are common, affecting over 70% of patients. Understanding these unintentional errors, like incomplete prescriptions and omissions, is key to improving patient safety and preventing adverse drug events.
Area of Science:
- Pharmacology and patient safety
- Internal medicine and hospital care
- Medication management and reconciliation
Background:
- Hospital discharge presents a high-risk period for medication discrepancies.
- These discrepancies can lead to drug-related problems, medication errors, and adverse drug events.
Purpose of the Study:
- To identify and characterize unintentional medication discrepancies at hospital discharge.
- To assess the clinical impact of these discrepancies on patient outcomes.
Main Methods:
- Prospective assessment of general internal medicine patients admitted for at least 72 hours.
- Comparison of a best possible medication discharge list with actual discharge prescriptions.
- Exclusion of patients with verbal prescriptions, death, or transfers to/from nursing homes or other institutions.
Main Results:
- Over 70% of patients (106/150) had at least one unintentional medication discrepancy.
- Actual discrepancies occurred in 41.3% of patients, and potential discrepancies in 55.3%.
- Common discrepancies included incomplete prescriptions (49.5%) and medication omissions (22.9%), with 29.5% having potential clinical impact.
Conclusions:
- Unintentional medication discrepancies are frequent upon hospital discharge.
- Identifying discrepancy types and frequencies aids in developing prevention strategies.
- Structured medication reconciliation processes may reduce discharge medication errors.
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