Background:
The eighth National Patient Safety Goal, developed by the Joint Commission in 2009, emphasizes the significance of reconciliation of medications during the entire period of hospitalization. Inaccuracies in the home medication list may lead to medication errors and possible adverse drug events which often persist across transitions in care. Prior study at our institution found that 92% of patients on the general medicine service had at least 1 error on written physicianobtained medication history, with an average of 3.8 errors per patient. Since then, our center has implemented use of electronic medication reconciliation. The objective of the study was to investigate whether electronic medication reconciliation decreased the rate of admission medication errors compared with the prior handwritten process.
Methods:
Consenting patients aged 18 years or older who were admitted to the general medicine service at an urban academic medical center were interviewed by a trained pharmacy student. Medication history was obtained from the patient, using a translator if needed, and verified by their pharmacy. This list was then compared to the standard physicianobtained medication list in the electronic medical record. Medication discrepancies between the 2 lists were then identified and noted as errors. Data were dichotomized for age (<65 or >65 years), language (English speaking vs. non–English speaking) and polypharmacy (>5 medications or < 5 medications used). The rates of medication history errors between electronic and hand‐written medication history were compared using logistic regression with a 95% confidence interval.
Results:
One hundred and twelve patients were interviewed. The average number of medication errors per patient was 3.5, and 82% of patients had at least 1 medication error. Logistic regression analysis revealed a 4.3fold increased risk of errors among polypharmacy patients after adjusting for the competing effects of age and language (95% CI, 1.5–12.4). Electronic medication reconciliation had a protective effect against medication history errors. After adjusting for the confounding effect of polypharmacy, data collected using the electronic medication history resulted in significantly lower error occurrence than traditional handwritten medication history (OR, 0.43; 95% CI, 0.20–0.95). One limitation of the study was compliance with electronic medication reconciliation, as 30.3% of patients’ medication reconciliations were incomplete.
Conclusions:
Multiple medication history errors per patient were identified following implementation of electronic medication reconciliation. Electronic medication reconciliation resulted in a significant reduction in the rate of medication history errors compared with handwritten medication history, but physicians’ compliance needs to be improved in order to fully benefit from this implementation.
Disclosures:
J. Quartarolo ‐ none; E. Tsang ‐ none; K. Hollenbach ‐ none