title: Validating reasons for medication discontinuation in electronic patient records at hospital discharge.
abstract: OBJECTIVE
  The accuracy of health care professionals in reporting safety events determines their usefulness for both system improvement and research. The study objectives were to: (1) validate (assess the accuracy of) the reasons recorded by doctors and pharmacists for discontinuing medication orders at discharge in a hospital's electronic patient records (EPR); (2) investigate the causes of any detected recording inaccuracy; and (3) collect preliminary data on the frequency and types of medication discontinuation.
  
  
  METHODS
  This was a validation study in one English hospital. The study comprised two steps: extraction of discontinued medication orders from the EPR followed by short structured interviews with doctors and pharmacists who made the discontinuation. A total of 104 discontinued orders were discussed during 15 face-to-face and six telephone interviews. The software package spss was used for data analysis.
  
  
  RESULTS
  Duplication of therapy (27, 25.2%), omission of drug (23, 21.5%) and dosage regimen change (19, 17.8%) were the three most frequent reasons given for discontinuing medications. The majority of recorded discontinuation reasons were correct (100, 96.2%) and complete (101, 97.1%), and hence were judged accurate (97, 93.3%). The difference in accurate recording between doctors (15, 88.2%) and pharmacists (82, 94.3%) was not statistically significant. Potential causes of recording inaccuracy included: slip or lapse, lack of training, carelessness and electronic system rigidity.
  
  
  CONCLUSIONS
  This study showed that doctors and pharmacists recorded accurate reasons for the majority of the discontinued medication orders. It also showed that utilizing pharmacists' recorded reasons during clinical interventions using EPR was beneficial in understanding and characterizing prescribing errors. Although they require further research, the reasons identified present preliminary data about the most prevalent types of pharmacists' interventions during hospital discharge.
authors.affiliation: School of Pharmacy and Pharmaceutical Sciences, The University of Manchester, Manchester, UK. dbalawi@hotmail.com
authors.forename: Derar H
authors.initials: DH
authors.lastname: Abdel-Qader
authors.forename: Judith A
authors.initials: JA
authors.lastname: Cantrill
authors.forename: Mary P
authors.initials: MP
authors.lastname: Tully
mesh_terms: D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D055695:Electronic Prescribing; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010595:Pharmacists; D010820:Physicians; D012189:Retrospective Studies