Drug record discrepancies in an outpatient electronic medical record: frequency, type, and potential impact on patient care at a hemodialysis center.
BACKGROUND
Patients who require hemodialysis take many drugs. Electronic drug records may be discrepant with what patients are actually taking. Record discrepancies are a potential source of drug-related problems. We sought to determine the extent to which drug record discrepancies occur in a hemodialysis population.


METHODS
This was a prospective observational study of patients enrolled in a pharmacist clinic at an outpatient hemodialysis center from August-December 2001. Patients participated in monthly drug interviews conducted by a pharmacist, during which patient drug use was determined. Data collected consisted of patient demographics, drug type, and number of drugs. Drug record discrepancies were classified and assigned a potential drug-related problem. Results were compared with the electronic drug record. Patients with documented drug record discrepancies were compared with those patients for whom no discrepancy was identified.


RESULTS
Over the 5-month period, 215 drug interviews were conducted in 63 patients. One hundred thirteen drug record discrepancies were identified in 38 patients (60%). Discrepancies (mean +/- SD 1.7 +/- 1.3, range 1-7) were identified during 65 drug interviews (30.2%). Electronic drug records were discrepant by one drug record, two drug records, and more than two drug records 60.0%, 26.2%, and 13.8% of the time, respectively. Drug record discrepancies placed patients at risk for adverse drug events and dosing errors in 49.6% and 34.5%, respectively, of 113 discrepancies. Patient age negatively correlated with the number of drug record discrepancies identified (r = -0.27, p = 0.04).


CONCLUSIONS
Drug record discrepancies occur frequently among patients undergoing hemodialysis. Incorporation of a pharmacist into the patient care team may increase the accuracy of the electronic drug record and avert unnecessary drug-related problems.
Manley
Harold J
HJ
Department of Pharmacy Practice, University of Missouri-Kansas City, MO 64102, USA. ManelyH@UMKC.edu
Drayer
Debra K
DK
McClaran
Marcy
M
Bender
Walter
W
Muther
Richard S
RS
D000553:Ambulatory Care; D004347:Drug Interactions; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D016347:Medical Records Systems, Computerized / Q000592:standards*; D008508:Medication Errors / Q000706:statistics & numerical data; D008875:Middle Aged; D008923:Missouri; D017063:Outcome Assessment, Health Care; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D011446:Prospective Studies; D006435:Renal Dialysis; D012646:Self Administration / Q000706:statistics & numerical data*
D004364:Pharmaceutical Preparations