Effect of education on the recording of medicines on admission to hospital.
BACKGROUND
The inaccurate recording of medicines on admission to hospital is an important cause of medication error. Medication reconciliation has been used to identify and correct these errors.


OBJECTIVE
To determine if a multimodal intervention involving medication reconciliation with real-time feedback and education would reduce the number of errors made by medical staff when recording medicines at the time of admission to hospital.


METHODS
Observational study.


METHODS
Patients admitted to the general medical wards of a teaching hospital were studied prospectively. Patients > or =75 years of age and on > or =5 medications were identified as the 'target group.'


METHODS
After admission, a second medication history was taken, and discrepancies were identified and communicated to the medical teams. An educational intervention to encourage prescribers to obtain accurate medication histories was conducted at the same time.


METHODS
The discrepancy rate was measured before and after the intervention.


RESULTS
There were 470 admissions in the 'target group.' Three hundred and thirty-eight of the admissions (71.9%) had one or more unintentional discrepancies. Although many discrepancies had little potential to cause harm, 33% were rated as clinically significant. During the study the discrepancy rate (prior to reconciliation) fell from 2.6 (SD 2.6) to 1.0 (SD 1.1) per admission (p < 0.0001). This decline in discrepancy rate remained significant (p = 0.001) even when only clinically important discrepancies were included. The proportion of admissions with one or more clinically important discrepancies also decreased during the study from 46% to 24% (p = 0.023).


CONCLUSIONS
Errors in the recording of medicines at the time of hospital admission are common. Combining the feedback provided by medication reconciliation with prescriber education reduced the error rate. This approach may be useful when the resources are not available to perform medication reconciliation for all patients admitted to hospital.
Department of Pharmacology and Clinical Pharmacology, University of Auckland, Auckland, New Zealand. AChan@adhb.govt.nz
Amy Hai Yan
AH
Chan
Elizabeth
E
Garratt
Benjamin
B
Lawrence
Nicholas
N
Turnbull
Priya
P
Pratapsingh
Peter N
PN
Black
D000368:Aged; D000369:Aged, 80 and over; D004501:Education, Medical; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008499:Medical Records; D008508:Medication Errors / Q000517:prevention & control*; D010343:Patient Admission; D004364:Pharmaceutical Preparations; D011446:Prospective Studies
D004364:Pharmaceutical Preparations