title: Do Orthogeriatric Inpatients Have a Correct Medication List? A Pharmacist-Led Assessment of 254 Patients in a Swedish University Hospital.
abstract: BACKGROUND
  Comorbidities and polypharmacy complicate the treatment of geriatric patients with acute orthopedic injuries. A correct medication history and an updated medication list are a prerequisite for safe treatment of these debilitated patients. Published evidence suggests favorable outcomes with comanaged care. The aim of this study was to assess the accuracy of the inpatient medication lists generated at admission and investigate the efficacy of a dedicated ward-based pharmacist to find and correct mistakes in these lists.
  
  
  METHODS
  A total of 254 patients were enrolled. The ward-based pharmacist performed the assessment regarding the accuracy of the medication list generated at admission by the method of medication reconciliation. Number of discrepancies and types of discrepancy were noted.
  
  
  RESULTS
  The 254 patients (176 women) had a mean age of 85 years (standard deviation 7.4 years, range 42-100 years). The most common reason for orthopedic admission was hip fracture. The mean number of discrepancies was 2.1 for all patients (range 0-13). Omission of a prescribed drug was the most common mistake. Fifty-six (22%) of the 254 assessed patients had a correct medication list.
  
  
  CONCLUSIONS
  The many discrepancies in our study may have several explanations but highlight the difficulties in taking a correct medication history of patients in a stressful environment with an extremely high workload. Moreover, electronic medication lists create challenges. Implementing new electronic tools for health care requires feedback, redesign, and adaptation to meet various needs of the users.
  
  
  CONCLUSIONS
  In conclusion, orthogeriatric patients have an unsatisfactory high number of discrepancies in their medication lists. Clinical pharmacists can accurately identify many of these mistakes.
authors.affiliation: Department of Orthopaedics, Institution of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Olof
authors.initials: O
authors.lastname: Wolf
authors.affiliation: Department of Orthopaedics, Institution of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Åberg
authors.affiliation: Department of Orthopaedics, Institution of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Tornberg
authors.affiliation: Department of Orthopaedics, Institution of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Jonsson
keywords: discrepancies; medication list; medication reconciliation; orthogeriatric; pharmacist