Discharge summary medication list accuracy across five metropolitan hospitals: a retrospective medical record audit

Objective To determine the accuracy of discharge summary (DS) medication lists across a broad cross-section of hospital inpatients and to determine what factors may be associated with errors in this document. Methods A retrospective medical record audit was undertaken at five metropolitan hospitals that utilise an electronic medication management system (eMMS) at the point of discharge. Four hospitals utilised an eMMS for inpatient medication management, with the fifth utilising the paper-based National Inpatient Medication Chart (NIMC). Any inpatients discharged during the first week of February, May, August and November 2020 and February 2021 were included if they received both a DS and either a pharmacy-generated patient-friendly medication list or interim medication administration chart. Results Eight-hundred and one DSs were included, of which 525 (66%) had one or more medication errors and 220 (27%) had one or more high-risk medication errors. A higher proportion of patients with polypharmacy (five or more medications) had one or more errors compared to patients without polypharmacy (67% vs 54%, P  < 0.01). DSs generated from the site with paper NIMCs were less likely to have one or more errors when compared to sites using an inpatient eMMS (58% vs 68%, P  < 0.01). Age, sex, language spoken and preparing the DS post-discharge were not associated with differing rates of errors. Of the 2609 individual medication errors (390 high-risk errors), the most common types were 'omitted drug or dose' (34%) and 'unnecessary drug' (33%). Conclusion Medication errors in the DS are common and more likely to occur in patients with polypharmacy.