title: A formal medication reconciliation programme in a haemodialysis unit can identify medication discrepancies and potentially prevent adverse drug events.
abstract: BACKGROUND
  Patients on haemodialysis have been identified as high-risk for medication discrepancies and adverse drug events. Medication reconciliation is an important patient safety initiative to prevent adverse drug events. The primary objective of our study was to determine the number and types of medication discrepancies and drug therapy problems (DTPs) identified in patients on haemodialysis. Our second objective was to assess the potential clinical impact and severity of all unintentional medication discrepancies identified.
  
  
  METHODS
  Patients in an academic haemodialysis unit were interviewed to obtain a best possible medication history (BPMH) between May and August 2010. The BPMH was documented and discrepancies were identified, classified and resolved with the interprofessional team. An interprofessional panel conducted a discrepancy clinical impact assessment for potential adverse drug events.
  
  
  RESULTS
  Two hundred and twenty-eight patients on haemodialysis were interviewed and 512 discrepancies were identified for 151 patients (3.4 discrepancies per patient). Of these, 174 (34%) were undocumented intentional discrepancies and 338 (66%) were unintentional discrepancies. The unintentional discrepancies were classified as 21% omissions, 36% commissions and 43% incorrect dose/frequency. Most drug therapy problems were related to patient taking a medication that was not indicated (25%), medication required but patient not taking (25%), patient not willing to take the medication as prescribed (28%) or incorrect dosing of a drug (20%). Overall, 6% of discrepancies were classified as clinically significant potential adverse drug events.
  
  
  CONCLUSIONS
  Medication discrepancies appear to be common in patients on haemodialysis. Formal interprofessional medication reconciliation practice models are essential to identify discrepancies and prevent patients from experiencing adverse drug events.
authors.affiliation: Leslie Dan Faculty of Pharmacy - University of Toronto, Toronto Ontario, Canada.
authors.forename: Winnie Wy
authors.initials: WW
authors.lastname: Chan
authors.affiliation: Leslie Dan Faculty of Pharmacy - University of Toronto, Toronto Ontario, Canada.
authors.forename: Geetha
authors.initials: G
authors.lastname: Mahalingam
authors.affiliation: Division of Nephrology, University Health Network; Toronto, Ontario, Canada.|Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Robert Ma
authors.initials: RM
authors.lastname: Richardson
authors.affiliation: Leslie Dan Faculty of Pharmacy - University of Toronto, Toronto Ontario, Canada.|University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Olavo A
authors.initials: OA
authors.lastname: Fernandes
authors.affiliation: Leslie Dan Faculty of Pharmacy - University of Toronto, Toronto Ontario, Canada.|University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Marisa
authors.initials: M
authors.lastname: Battistella
mesh_terms: D000328:Adult; D000368:Aged; D064420:Drug-Related Side Effects and Adverse Reactions / Q000451:nursing* / Q000517:prevention & control*; D005260:Female; D006436:Hemodialysis Units, Hospital; D006801:Humans; D007676:Kidney Failure, Chronic / Q000451:nursing*; D008297:Male; D055118:Medication Adherence; D059065:Medication Reconciliation / Q000458:organization & administration*; D008875:Middle Aged; D064647:Nephrology Nursing; D063046:Patient Medication Knowledge; D000067561:Potentially Inappropriate Medication List; D011446:Prospective Studies
keywords: Adverse events; Haemodialysis; Medication reconciliation