Medication discrepancies at discharge from an internal medicine service.
BACKGROUND
Medication errors most commonly occur at the time of medication prescribing and particularly at the moment of the transitions of care. The objectives of this study were to identify and characterize the discrepancies between the physicians' discharge medication orders and the medication lists at admission obtained by an internal medicine specialist physician in a general internal medicine service.


METHODS
This descriptive, retrospective, study was carried out at a tertiary care university teaching hospital in Spain. It was based on the review of non selected, consecutive, hospital discharge reports. Discrepancies were identified, categorized and characterized through the analysis of the information (medication lists, laboratory tests results, diagnosis, and clinical evolution) contained in them.


RESULTS
We analyzed 954 discharge reports. In the medication reconciliation process, we find discrepancies in 832 (87.2%) of them. Justified discrepancies were found in 828 (86.8%) reports and unjustified discrepancies in 52 (5.4%). Omission of a medication was the most frequent medication error detected in 86.4% of cases, followed by incomplete prescription (9.6%). The number of diagnosis, the length of hospital stay and the number of permanent medications at admission were the characteristics of cases associated with medication discrepancies in multivariate linear regression (P<0.01).


CONCLUSIONS
Although considering the limitations in its design, it is remarkable the low number of medication errors detected in our study. Appropriate routines to ensure an accurate medication history collection and a methodical elaboration of the medication list at discharge, when performed by trained internists, are important for an adequate medication reconciliation process.
Service of Internal Medicine-Los Montalvos, University Hospital of Salamanca, Los Montalvos s/n, 37192 Salamanca, Spain. jherreroh@saludcastillayleon.es
José-Ignacio
JI
Herrero-Herrero
Judit
J
García-Aparicio
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data*; D008297:Male; D008485:Medical Audit; D008487:Medical History Taking; D008508:Medication Errors / Q000706:statistics & numerical data*; D008510:Medication Systems, Hospital / Q000706:statistics & numerical data; D008875:Middle Aged; D010343:Patient Admission / Q000592:standards / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology