Background:
Medication errors represent an important hospital safety issue, yet patients are largely excluded from active involvement in detecting and preventing these events. The magnitude of the problem is staggering, with 1 review finding almost 1 in every 5 medication doses in error. Administration errors are particularly difficult to prevent. The patient, as the last link in the chain, represents the final individual capable of preventing a medication error. We performed a pilot study to assess patient understanding of their medications during hospitalization and attitudes toward greater involvement in the safety process.
Methods:
This was a prospective cohort study of 50 medicine inpatients. Patients were surveyed and asked to list their hospital medications. The primary outcomes were the proportions of PRN, scheduled, and total medications omitted by the patient compared with the hospital medication administration record. ANOVA models employed assessed relationship between primary outcomes and each of 3 patient characteristics: age (<65 or >65 years), self‐reported knowledge of hospital medications, and self‐reported desire to be involved in medication safety. The protocol was approved by the institutional review board.
Results:
The average age was 54 years (21–89 years), 46% were male, 74% were white. Ninely‐six percent of patients (48 of 50) omitted at least 1 hospital medication, with the inability to name an average of 6.8 medications (Table 1). Forty‐four percent (22 of 50, Cl 43%–100%) believed they were receiving a medication that was not prescribed. Patients < 65 years omitted 60% of their PRN medications, whereas patients > 65 years omitted 88% (P = 0.01). This difference remained after adjusting for number of medications. There were no other significant differences found between the primary outcomes and the examined patient characteristics. Only 28% of patients (14 of 50) reported having seen their hospital medication list, although 78% (39 of 50) favored being given such a list, and 81 % (39 of 48) reported this would improve satisfaction with their care. Ninety percent (45 of 50) wanted to review their hospital medication list for accuracy, and 94% (47 of 50) felt this had the potential to reduce errors.
Table 1. Patient Understanding of Their Hospital Medications
Conclusions:
Patients represent the last line of defense against medication errors in the hospital, yet our study suggests patients are disenfranchised from participating in their own medication safety. Without systematically educating patients on their hospital medications, significant deficits in patient knowledge are inevitable. Although some might argue that patients should not be asked to perform such a critical role while sick and vulnerable, our research indicates patients are willing to have an active role and believe that they have the potential to prevent errors. The unintended consequence of expectation of patient passivity is to limit the opportunity to utilize the patient as a part of the system of medication safety. Our findings are a call to reexamine how we educate patients regarding hospital medications and to work to incorporate the patient into the culture of medication safety.
Author Disclosure:
E. Cumbler, none; H. Wald, none; J. S. Kutner, none.