Medication Safety: an audit of medication discrepancies in transferring type 2 diabetes mellitus (T2DM) patients from Australian primary care to tertiary ambulatory care.
OBJECTIVE
To identify, classify and determine the factors associated with medication discrepancies for type 2 diabetes mellitus (T2DM) patients, referred from primary care to a tertiary ambulatory clinic.


METHODS
Retrospective audit of outpatient clinic records.


METHODS
Royal Prince Alfred Hospital (RPAH) Diabetes Ambulatory Care Centre.


METHODS
300 randomly selected adult T2DM patients who attended the Diabetes Centre between 01 January 2010 and 31 December 2011.


METHODS
The rates and types of medication discrepancies were identified by comparing the structured nurse-patient interview (SNPI) with the primary care [General Practitioner (GP)] referral letter, where the SNPI was considered the best possible medication history. Discrepancies were identified as addition, omission, dose and insulin-type discrepancies. Each category was mutually exclusive.


RESULTS
Over 80% of referral letters contained at least one discrepancy with a median of two discrepancies per referral. Of a total of 744 discrepancies, the majority were omissions (58.9%). Insulins had the highest discrepancy rate. Factors independently associated with medication discrepancies were GP referral letter type, total number of medications and medication regimen type.


CONCLUSIONS
A high rate of medication discrepancies was found in GP referral letters for patients referred to this clinic. Automated GP referral letters and inaccurate GP records may have contributed to this, highlighting the need for routine medication reconciliation at transitions of care, to ensure prescribers have access to correct medication information to inform decision-making and ensure optimal patient outcomes.
Faculty of Pharmacy, University of Sydney, Sydney, NSW 2006, Australia.
Madonna
M
Azzi
Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia.
Maria
M
Constantino
Sydney Nursing School, University of Sydney, Sydney, NSW 2006, Australia.
Lisa
L
Pont
Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia.
Margaret
M
Mcgill
Sydney Medical School, The University of Sydney, Sydney, NSW 2050, Australia Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia.
Stephen
S
Twigg
Faculty of Pharmacy, University of Sydney, Sydney, NSW 2006, Australia.
Ines
I
Krass
D000368:Aged; D001315:Australia; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data; D059065:Medication Reconciliation; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data
D007004:Hypoglycemic Agents
medication discrepancies; medications; primary care; tertiary care; type 2 diabetes mellitus