Documentation and appropriateness of prescribing for Veterans Administration ambulatory-care patients

Information about active prescriptions in pharmacy medication profiles of outpatients at a Veterans Administration (VA) medical center was compared with corresponding information in the medical records to determine the completeness of prescription documentation. Appropriateness of prescribing was assessed by comparison with explicit criteria. Information about the active prescriptions included in 300 randomly selected patient medication profiles was collected from August to October 1984. The completeness of prescription information documentation was determined by comparing the data obtained from the patient's medication profile with the corresponding medical record entry. Medication profiles were screened for three types of potentially inappropriate prescribing: inappropriate daily dosage, inappropriate duplication of therapy, and interacting drug combinations. A total of 287 patient medication profiles and medical records were studied. Only 60 medical records (20.9%) had accurate documentation of all drug names, drug strengths, and directions for use when compared with the medication profiles. Evidence of potentially inappropriate prescribing was present in medication profiles of 43.4% of the patients. Medical record documentation was insufficient for a provider to detect 50.0% of the dosage deviations, 33.3% of the duplications of therapy, and 26.1% of the drug-drug interactions. The probability that evidence of potentially inappropriate prescribing would be present in a medication profile increased as the number of drugs per patient increased. However, there was no significant positive association between insufficient medical-record documentation and the presence of any of the three indicators of potentially inappropriate prescribing in the medication profile.(ABSTRACT TRUNCATED AT 250 WORDS)