title: Omitted and unjustified medications in the discharge summary.
abstract: BACKGROUND
  Limited information exists in regard to drug omissions and unjustified medications in the hospital discharge summary (DS).
  
  
  OBJECTIVE
  To evaluate the incidence and types of drug omissions and unjustified medications in the DS, and to assess their potential impact on patient health.
  
  
  METHODS
  A prospective observational review of the DSs of all patients discharged from our Internal Medicine Department over a 3-month period. Data assessment was made by internists using a structured form.
  
  
  RESULTS
  Of the 577 evaluated DSs, 66% contained at least one inconsistency accounting for a total of 1012 irregularities. There were 393 drug omissions affecting 251 patients, 32% of which were potentially harmful. Seventeen per cent of all medications (619/3691) were unjustified, affecting 318 patients. The unjustified medication was potentially harmful in 16% of cases, occurred significantly more frequent in women than in men (61% vs 50%; p = 0.008) and increased linearly with the number of drugs prescribed (p<0.001). Drug omission had a twofold higher potential to cause harm than unjustified medication.
  
  
  CONCLUSIONS
  Drug omissions and unjustified medications are frequent, and systemic changes are required to substantially reduce these inconsistencies.
authors.affiliation: Intensive Care Unit, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland. andreas.perren@eoc.ch
authors.forename: A
authors.initials: A
authors.lastname: Perren
authors.forename: M
authors.initials: M
authors.lastname: Previsdomini
authors.forename: B
authors.initials: B
authors.lastname: Cerutti
authors.forename: D
authors.initials: D
authors.lastname: Soldini
authors.forename: D
authors.initials: D
authors.lastname: Donghi
authors.forename: C
authors.initials: C
authors.lastname: Marone
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records / Q000592:standards*; D008508:Medication Errors; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D055553:Prescription Drugs; D011446:Prospective Studies; D013557:Switzerland
chemical_list: D055553:Prescription Drugs