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International Journal of Clinical Pharmacy

, Volume 34, Issue 1, pp 113–119 | Cite as

The effect of medication reconciliation in elderly patients at hospital discharge

  • Patrik MidlövEmail author
  • Leila Bahrani
  • Mehran Seyfali
  • Peter Höglund
  • Eva Rickhag
  • Tommy Eriksson
Research Article

Abstract

Objective To assess the impact of medication reconciliation interventions on medication error rates when elderly patients are discharged from hospital to community care or nursing homes.Setting Elderly patients (>65 years) living in nursing homes or in their own homes with care provided by the community nursing system. Method All medical records containing information on drug treatment were collected from hospital departments, the community care service and GPs. We then identified if there were any changes in the transfer of information i.e. if the drugs were not the same as before the transfer. Two different persons independently evaluated all information about the patients’ drugs to identify medication errors for three different time periods. During all three periods structured discharge information was used. In period 2, electronic medication lists were introduced and in period 3 we introduced specific routines and support by a clinical pharmacist to ensure prescription in the specific medication dispensing system (ApoDos). Asymptotic Linear by–Linear Association Test was used to compare number of medication errors in period 1, 2 and 3 respectively. Main outcome measure Number of medication errors per patient. Results A total of 123 patients were evaluated at discharge. For the 109 patients using the ApoDos system, there were significant differences in the number of medication errors between period 1 and 3 (P = 0.048), period 2 and 3 (P = 0.037 but not between period 1 and 2 (P = 0.41). The mean numbers of errors were 1.5, 1.1 and 0.5 for period 1, 2 and 3 respectively. The 14 patients not using the ApoDos system had on average 0.4 errors per patient. Among the 58 patients with medication errors, 34 were evaluated as having low clinical risk, 22 moderate, and 2 high clinical risk. Conclusion Medication errors are still common when elderly patients are transferred from hospital to community/primary care. The main risk factor seems to be the specific medication dispensing system (ApoDos) or rather the process on how to use it. When this system was supported by clinical pharmacists, the error rate dropped to the same level as for patients without ApoDos.

Keywords

Drug-related problems Elderly Hospital pharmacy Medication errors Medication reconciliation Sweden 

Notes

Acknowledgments

We would like to thank the staff at the Department of Internal Medicine at Landskrona Hospital and the nurses in the community health care.

Funding

We are grateful to the Governmental Funding of Clinical Research within the NHS (ALF) and the National Board of Health and Welfare for funding the study.

Conflicts of interest

There are no conflicts of interest.

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Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Patrik Midlöv
    • 1
    Email author
  • Leila Bahrani
    • 1
  • Mehran Seyfali
    • 1
  • Peter Höglund
    • 2
  • Eva Rickhag
    • 3
  • Tommy Eriksson
    • 2
    • 4
  1. 1.Department of Clinical Sciences Malmö, Center for Primary Health Care ResearchLund UniversityMalmöSweden
  2. 2.Department of Clinical PharmacologyLund UniversityLundSweden
  3. 3.Department of MedicineLund University HospitalLundSweden
  4. 4.Apoteket Farmaci AB, Hospital PharmacyLund University HospitalLundSweden

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