Original Contributions
Medication List Assessment in Spanish Hospital Emergency Departments

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Abstract

Background

Medication errors lead to morbidity and mortality among emergency department (ED) patients. An inaccurate medication history is one of the underlying causes of these errors.

Objectives

This study was performed to determine the prevalence of patients with discrepancies between the medical list information contained in the clinical history compiled on admission to the ED and the list of medications patients are actually taking, to characterize the discrepancies found, and to analyze whether certain factors are associated with the risk of discrepancies.

Methods

We conducted a cross-sectional, descriptive, observational, multicenter study with an analytic component in the EDs of 11 hospitals in Spain. We compared pharmacist-obtained medication lists (PML) with ED-obtained medication lists (EDML). Discrepancy was defined as one or more differences (in drug or dosage or route of administration) between the EDML and PML. The endpoints were the proportion of patients with discrepancies in their home medical lists, and the prevalence of certain factors among patients with discrepancies and those without.

Results

We detected 1476 discrepancies in 387 patients; no discrepancies were found in 20.7%. The most frequent discrepancies involved incomplete information (44.2%) and omission (41.8%). In the bivariate analysis, age, number of medications, and Charlson comorbidity score were significantly associated with discrepancy. In the multivariate analysis, number of medications and hospital were the variables associated with discrepancy.

Conclusions

The EDML differed from the list of medications patients were actually taking in 79.3% of cases. Incomplete information and omission were the most frequent discrepancies. Age, number of medications, and comorbidities were related to the risk of discrepancies.

Introduction

Patient safety strategies are essential to ensure quality of care (1). The World Alliance for Patient Safety recommends ensuring the accuracy of information about medication during transitions in care (1). Half of medication errors occur in the processes of transition of care (2). The Joint Commission on Accreditation of Health Care Organizations stresses that medication reconciliation at the various points in the health care process when attending staff change is the key to reducing the number of adverse drug effects (3).

Medication reconciliation is a formal process to obtain a complete current list of a patient's medications at points where patient care is transferred to ensure correct prescription after transfer. Errors in medication reconciliation result in unintentional discrepancies between medication prior to and after the transfer of care (4). The main step in the medication reconciliation process is to draw up a complete, reliable list of the patient's home medications to prevent medication errors.

Studies in the United States, Canada, and the United Kingdom report rates of medication reconciliation errors ranging from 26.9% to 65% 5, 6, 7. In a systematic review of 22 studies involving a total of 3755 patients, Tam et al. found that 27–54% of patients had at least one medication history error and that 19–75% of the discrepancies were unintentional (8). A previous study in Spain reported 167 medical reconciliation errors in 76 patients (45.5%); 69% of these errors occurred at admission (9). Other studies show that clinical histories taken in different areas of the hospital do not thoroughly record information about patients' medications 10, 11, 12. Incomplete information can lead to ineffective or unsafe drug treatment.

Obtaining a complete medication history in the emergency department (ED) would help avoid medication errors. However, the urgent nature of ED treatment and the need to make decisions quickly make it difficult to obtain a thorough medication history. Nevertheless, the unavailability of a complete medication history increases the risk of medication errors (e.g., omissions, duplications) both in the ED and after transfer of care.

In a Spanish study, Gutierrez et al. reviewed ED prescriptions for 177 patients and found 141 prescribing errors in 50 patients (13). Assessing physicians considered the potential impact of the errors very significant in 12% of cases and significant in 52% of cases. Iniesta Navalón et al. found 2928 discrepancies involving 95.1% of patients over 65 years of age who were assessed on admission (24–48 h) to their ED (14).

In the present study, we aimed to determine the prevalence of patients with discrepancies between the medications they were actually taking prior to admission to the ED and the information about these medications recorded in the clinical history taken on admission to the ED at 11 hospitals in Spain, characterize the discrepancies found, and explore the factors associated with discrepancies.

Section snippets

Materials and Methods

We conducted a cross-sectional, descriptive, observational, multicenter study with an analytic component in the EDs of 11 hospitals in Spain. Each hospital conducted the study during a 1-month period between November 2009 and February 2010. All the participating hospitals were General Hospitals, which are hospitals where patients with many different ailments are given care, and which offer medical, surgical, obstetric, gynecological, and pediatric services (15). Hospitals are also considered to

Results

The sample size calculated for all hospitals was 387 patients. The patient sample size range in all ED observation areas was 21–49. The sample size was stratified by the number of patients in each ED observation area for the participating hospital, range 50.665–118.329. The sample size included 50.1% women; mean age 67 years; age range 18–101 years; the average age was 67.2 ± 19.48 years and 62.5% of the patients were older than 65 years. Nearly 70% were responsible for taking their medication

Discussion

This multicenter study found discrepancies between the EDML and the PML in all 11 participating hospitals. Although all these hospitals volunteered to participate in the study, the patients included in the study are a representative sample of the patients who presented to the EDs of these hospitals. The study was carried out using the same methods, design, and definitions in all participating centers, and the homogeneous training and use of a structured interview minimized interviewer bias. Our

Conclusion

The high prevalence of discrepancies in the 11 hospitals participating in our study, which were located in different areas in Spain, underlines the need for medication reconciliation in busy departments like the ED. The most frequent discrepancies detected were errors of omission and incomplete medication lists, and these are easy to avoid through the active participation of the patient. This study shows that medication lists are not recorded correctly in Spanish EDs, and this could affect

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