Background Transition of care on admission to the hospital and between clinical areas are risk points for medication errors. All type of medication errors can be reduced by improving communication at each transition point of care. Objectives This study examines the impact of pharmacist obtained best possible medication histories on medication errors at admission due to unintentional medication discrepancies in older patients. Setting This was a prospective, single-center study conducted in an Internal Medicine Department of a tertiary care teaching hospital in Saudi Arabia. Methods Patients ≥ 65 years with an existing drug therapy on admission were eligible. The best possible medication history taken by the pharmacist from different sources of medication information was compared to the admission medication order to identify and correct unintentional discrepancies. The discrepancies were classified according to the type of errors. An independent multidisciplinary team adjudicated the potential for harm of each type of medication error. Main outcome measure Number and proportion of unintentional medication discrepancies upon admission and associated medication errors. Secondary outcomes included clinical significance and drug classes involved in the discrepancies and risk factors for the occurrence of these discrepancies. Results A total of 375 evaluable patients were identified. Among 375 medication histories, 609 discrepancies were detected of which 226 were recorded as unintentional. 151 patients (42.4%) had ≥ 1 unintended discrepancy. Drug omission (37%) was the most frequent type of error. Nervous system (24.5%), and cardiovascular system (21.2%) were the most common drug classes involved in medication errors. Three-fifths of the UMD had the potential to cause temporary harm with initial or prolonged hospitalization. The number of medications prescribed upon admission (OR 1.32, 95% CI 1.09–1.54, p < 0.034), number of sources consulted for the best possible medication history (OR 1.53, 95% CI 1.38–1.76, p < 0.01) and the completion of medication review process within 24 h (OR 0.89, 95% CI 0.86–0.94, p < 0.03) of the admission were the 3 most significant predictors of the discrepancies. Conclusions In elderly patients, medication histories are often recorded inaccurately by physicians at the time of hospital admission, this creates the potential for medication errors starting at admission. In older adults, best possible medication histories are also useful in detecting drug related pathology or drug–drug interactions.
This is a preview of subscription content, log in to check access.
Conflicts of interest
The authors declare that they have no conflicts of interest.
No external sources of funding were used for this study or for the writing, correction, and submission of this article.
Royal S, Smeaton L, Avery AJ, Hurwitz B, Sheikh A. Interventions in primary care to reduce medication related adverse events and hospital admissions: systematic review and meta-analysis. Qual Saf Health Care. 2006;15(1):23–31.CrossRefGoogle Scholar
Alhawassi TM, Krass I, Pont LG. Antihypertensive-related adverse drug reactions among older hospitalized adults. Int J Clin Pharm. 2018;40(2):428-35.CrossRefGoogle Scholar
Marcum ZA, Amuan ME, Hanlon JT, Aspinall SL, Handler SM, Ruby CM, et al. Prevalence of unplanned hospitalizations caused by adverse drug reactions in older veterans. J Am Geriatr Soc. 2012;60(1):34–41.CrossRefGoogle Scholar
Sultana Janet, Cutroneo Paola, Trifirò Gianluca. Clinical and economic burden of adverse drug reactions. J Pharmacol Pharmacother. 2013;4(Suppl1):S73–7.CrossRefGoogle Scholar
Formica D, Sultana J, Cutroneo PM, Lucchesi S, Angelica R, Crisafulli S, et al. The economic burden of preventable adverse drug reactions: a systematic review of observational studies. Expert Opin Drug Saf. 2018;17(7):681–95.CrossRefGoogle Scholar
Weant KA, Bailey AM, Baker SN. Strategies for reducing medication errors in the emergency department. Open Access Emerg Med. 2014;6:45.CrossRefGoogle Scholar
Wong JD, Bajcar JM, Wong GG, Alibhai SM, Huh JH, Cesta A, et al. Medication reconciliation at hospital discharge: evaluating discrepancies. Ann Pharmacother. 2008;42(10):1373–9.CrossRefGoogle Scholar
Munday A, Kelly B, Forrester J, Timoney A, McGovern E. Do general practitioners and community pharmacists want information on the reasons for drug therapy changes implemented by secondary care? Br J Gen Pract. 1997;47(422):563–6.PubMedPubMedCentralGoogle Scholar
Abdellatif A, Bagian JP, Barajas ER, Cohen M, Cousins D, Denham CR, et al. Assuring medication accuracy at transitions in care. Jt Comm J Qual Patient Saf. 2007;33(7):450–3.CrossRefGoogle Scholar
Joint Commission on Accreditation of Healthcare Organizations, USA. Using medication reconciliation to prevent errors. Sentin Event Alert. 2006;23(35):1–4.Google Scholar
Mazhar F, Akram S, Al-Osaimi YA, Haider N. Medication reconciliation errors in a tertiary care hospital in Saudi Arabia: admission discrepancies and risk factors. Pharm Pract (Granada). 2017;15(1):864.CrossRefGoogle Scholar
Leotsakos A, Zheng H, Croteau R, Loeb JM, Sherman H, Hoffman C, et al. Standardization in patient safety: the WHO High 5s project. Int J Qual Health Care. 2014;26(2):109–16.CrossRefGoogle Scholar
National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP), NCC MERP Index for Categorizing Medication Errors. http://www.nccmerp.org. Accessed 1 June 2016.
Quélennec B, Beretz L, Paya D, Blicklé JF, Gourieux B, Andrès E, et al. Potential clinical impact of medication discrepancies at hospital admission. Eur J Intern Med. 2013;24(6):530–5.CrossRefGoogle Scholar
WHO Collaborating Centre for Drug Statistics Methodology. Anatomic therapeutic chemical (ATC) classification index with defined daily doses (DDDs). WHO Collaborating Centre for Drug Statistics Methodology, Oslo, Norway. http://www.whocc.no/atcddd/ (2003). Accessed 5 Jan 2017.
Abdulghani KH, Aseeri MA, Mahmoud A, Abulezz R. The impact of pharmacist-led medication reconciliation during admission at tertiary care hospital. Int J Clin Pharm. 2018;40(1):196–201.CrossRefGoogle Scholar
AbuYassin BH, Aljadhey H, Al-Sultan M, Al-Rashed S, Adam M, Bates DW. Accuracy of the medication history at admission to hospital in Saudi Arabia. Saudi Pharm J. 2011;19(4):263–7.CrossRefGoogle Scholar
Rappaport R, Arinzon Z, Feldman J, Lotan S, Heffez-Aizenfeld R, Berner Y. The need for medication reconciliation increases with age. Isr Med Assoc J. 2017;19(10):625–30.PubMedGoogle Scholar
Suggett E, Marriott J. Risk factors associated with the requirement for pharmaceutical intervention in the hospital setting: a systematic review of the literature. Drugs Real World Outcomes. 2016;3(3):241–63.CrossRefGoogle Scholar
Pippins JR, Gandhi TK, Hamann C, Ndumele CD, Labonville SA, Diedrichsen EK, et al. Classifying and predicting errors of inpatient medication reconciliation. J Gen Intern Med. 2008;23(9):1414–22.CrossRefGoogle Scholar
Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R, Etchells EE. Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. Can Med Assoc J. 2005;173(5):510–5.CrossRefGoogle Scholar
Cortejoso L, Dietz RA, Hofmann G, Gosch M, Sattler A. Impact of pharmacist interventions in older patients: a prospective study in a tertiary hospital in Germany. Clin Interv Aging. 2016;11:1343.CrossRefGoogle Scholar
Fijn R, Van den Bemt PM, Chow M, De Blaey CJ, De Jong-Van den Berg LT, Brouwers JR. Hospital prescribing errors: epidemiological assessment of predictors. Br J Clin Pharmacol. 2002;53(3):326–31.CrossRefGoogle Scholar
Johnston R, Saulnier L, Gould O. Best possible medication history in the emergency department: comparing pharmacy technicians and pharmacists. Can J Hosp Pharm. 2010;63(5):359.PubMedPubMedCentralGoogle Scholar
Coleman EA, Smith JD, Raha D, Min S-J. Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005;165(16):1842–7.CrossRefGoogle Scholar
Hias J, Van der Linden L, Spriet I, Vanbrabant P, Willems L, Tournoy J, et al. Predictors for unintentional medication reconciliation discrepancies in preadmission medication: a systematic review. Eur J Clin Pharmacol. 2017;73(11):1355–77.CrossRefGoogle Scholar