title: Pharmacy dispensing of electronically discontinued medications.
abstract: BACKGROUND
  Most physician offices do not transmit orders for medication discontinuation to the pharmacy, creating the potential for errors in dispensing of previously prescribed medications. Electronic health records offer the potential to assess this patient safety concern.
  
  
  OBJECTIVE
  To assess the frequency of and potential patient harm associated with pharmacy dispensing of discontinued medications in the ambulatory setting.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Multispecialty group practice in eastern Massachusetts using an electronic health record.
  
  
  METHODS
  30 406 adult patients with an electronic discontinuation order for antihypertensive, antiplatelet, anticoagulant, oral hypoglycemic, and statin medications between November 2008 and October 2009.
  
  
  METHODS
  Dispensing of discontinued medications within 12 months and associated potential patient harm.
  
  
  RESULTS
  Among 83 902 targeted medications that were electronically discontinued, 1218 (1.5% [95% CI, 1.4% to 1.5%]) were subsequently dispensed by the pharmacy a mean of 1.0 (SD, 0.3) time during the 12-month follow-up. Among the top 10 most frequently electronically discontinued medications, the rate of subsequent dispensing by a pharmacy ranged from 0.9% for metformin to 2.5% for metoprolol. Manual chart review of 416 medication-dispensing events that were predefined as high risk according to an automated algorithm identified potential harm in 50 (12%) cases, including clinical reactions (n = 18), laboratory abnormalities (n = 17), duplicated medication classes dispensed (n = 8), and potential allergic reactions (n = 7).
  
  
  CONCLUSIONS
  Information on pharmacy dispensing was available for only 52% of medication orders.
  
  
  CONCLUSIONS
  The dispensing of discontinued medications represents an important ambulatory patient safety concern. Electronic health records should be used to facilitate better communication between providers and pharmacies and improve medication safety.
  
  
  BACKGROUND
  National Institutes of Health.
authors.affiliation: North Shore Physicians Group, 104 Endicott Street, Suite 104, Danvers, MA 01923, USA. aallen0@partners.org
authors.forename: Adrienne S
authors.initials: AS
authors.lastname: Allen
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Sequist
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D011307:Drug Prescriptions / Q000592:standards* / Q000706:statistics & numerical data; D057286:Electronic Health Records; D055695:Electronic Prescribing / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008404:Massachusetts; D008875:Middle Aged; D010594:Pharmacies / Q000592:standards* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment