title: Prevalence and risk factors for medication reconciliation errors during hospital admission in elderly patients.
abstract: Background Care transitions are risk points for medication discrepancies, especially in the elderly. Objective This study was undertaken to assess prevalence and describe medication reconciliation errors during admission in elderly patients and to analyze associated risk factors. We also evaluate the effect of these errors on the length of hospital stay. Setting General surgery, orthopedics, internal medicines and infectious diseases departments of a 1070-bed Spanish teaching hospital. Method This is a prospective observational study. Patients >65 years and taking ≥5 medications were randomly selected from those admitted to hospital. The pharmacist obtained the best possible medication history based on medical records, medical notes from patients' previous admissions to hospital, "brown bag" review, community care prescriptions, and comprehensive patient interviews. It was compared to current inpatient prescription to detect unintentional discrepancies (discrepancy with no apparent clinical explanation), which were reported to the physician. When the physician accepted the discrepancy by changing the medication order, it was recorded as a medication reconciliation error and classified by type of error. Several variables were analyzed as possible risk/protective factors. Main outcome measure Is prevalence of medication reconciliation errors at admission. Results Reconciliation was performed on 206 patients. Medication reconciliation errors occurred in 49.5 % (102/206) of patients. 1996 medications were recorded, and 359 had unintentional discrepancies (56.0 % (201/359) medication reconciliation errors). The most common was omission (65.1 %). Identified risk factors were as follows: physician experience, number of pre-admission prescribed medications, and previous surgeries. Computerized order entry system was a protective factor. Conclusion Medication reconciliation errors occur in almost half of the elderly patients at admission, especially omissions. Risk factors were a larger number of previous medications, less physician years of experience, and more previous surgeries. Having a computerized order entry system in the hospital protected against some errors.
authors: Pharmacy Department, Ramon y Cajal Hospital, Madrid, Spain. blancarv1@hotmail.com.
authors: Blanca
authors: B
authors: Rodríguez Vargas
authors: Pharmacy Department, Ramon y Cajal Hospital, Madrid, Spain.
authors: Eva
authors: E
authors: Delgado Silveira
authors: Complutense University, Madrid, Spain.
authors: Irene
authors: I
authors: Iglesias Peinado
authors: Pharmacy Department, Ramon y Cajal Hospital, Madrid, Spain.
authors: Teresa
authors: T
authors: Bermejo Vicedo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control* / Q000639:trends*; D059065:Medication Reconciliation / Q000379:methods* / Q000639:trends*; D010343:Patient Admission / Q000639:trends*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
keywords: Adverse drug event; Aged; Medication error; Medication reconciliation; Patient admission; Spain