Classifying and predicting errors of inpatient medication reconciliation.
BACKGROUND
Failure to reconcile medications across transitions in care is an important source of potential harm to patients. Little is known about the predictors of unintentional medication discrepancies and how, when, and where they occur.


OBJECTIVE
To determine the reasons, timing, and predictors of potentially harmful medication discrepancies.


METHODS
Prospective observational study.


METHODS
Admitted general medical patients.


METHODS
Study pharmacists took gold-standard medication histories and compared them with medical teams' medication histories, admission and discharge orders. Blinded teams of physicians adjudicated all unexplained discrepancies using a modification of an existing typology. The main outcome was the number of potentially harmful unintentional medication discrepancies per patient (potential adverse drug events or PADEs).


RESULTS
Among 180 patients, 2066 medication discrepancies were identified, and 257 (12%) were unintentional and had potential for harm (1.4 per patient). Of these, 186 (72%) were due to errors taking the preadmission medication history, while 68 (26%) were due to errors reconciling the medication history with discharge orders. Most PADEs occurred at discharge (75%). In multivariable analyses, low patient understanding of preadmission medications, number of medication changes from preadmission to discharge, and medication history taken by an intern were associated with PADEs.


CONCLUSIONS
Unintentional medication discrepancies are common and more often due to errors taking an accurate medication history than errors reconciling this history with patient orders. Focusing on accurate medication histories, on potential medication errors at discharge, and on identifying high-risk patients for more intensive interventions may improve medication safety during and after hospitalization.
Pippins
Jennifer R
JR
Division of General Medicine, Brigham and Women's Hospital, Boston, MA 02120-1613, USA.
Gandhi
Tejal K
TK
Hamann
Claus
C
Ndumele
Chima D
CD
Labonville
Stephanie A
SA
Diedrichsen
Ellen K
EK
Carty
Marcy G
MG
Karson
Andrew S
AS
Bhan
Ishir
I
Coley
Christopher M
CM
Liang
Catherine L
CL
Turchin
Alexander
A
McCarthy
Patricia C
PC
Schnipper
Jeffrey L
JL
D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008487:Medical History Taking; D008508:Medication Errors; D008510:Medication Systems, Hospital; D008875:Middle Aged; D010343:Patient Admission; D010351:Patient Discharge; D011446:Prospective Studies