Prevalence of Medication Discrepancies and its related Causes In Emergency Department

Introduction:

Hospital admission is an interface of care when patients are at a high risk of medication discrepancies as they transition from home to hospital. These discrepancies are important, as they may contribute to drug-related problems, medication errors, and adverse drug events.

Objectives:

This study was conducted to evaluate the prevalence of medication discrepancies and its affecting factors using medication reconciliation method in patients admitted to the emergency department.

Study Design:

Patients were over 18years, with at least one chronic disease that used 2regular prescription medications enrolled. 

Methods:

This cross-sectional study was conducted with a sample size of 200 patients admitted to the emergency department of a tertiary care teaching hospital during 8 months. After 24hours of admission, demographic data and patient's home medications were collected using the questionnaire, interview and medical records. Medication discrepancies were assessed through comparison of a best possible medication history list with the physician orders at the medical records.

Results:

Out of 200patients (mean age,61.5yrs;86males,114women), 169(84.5%) patients had one or more medication discrepancies and 31(15.5%) of them did not have any discrepancy. The medication discrepancy frequency was 84.5%. The most common discrepancies were medication omission(35.49%), change(11.12%), replacement (10.97%), and discontinue(3.09%) respectively. The relationship between age, gender, Education, working shifts with the medication discrepancy were not statistically significant(all P>0.05). Cardiovascular drugs (WHO ATC Index) compared to other medications classes showed the highest discrepancies(36.2%). Multiple logistic regression showed that the drug groups, including Anti-infective for Systemic use(OR=8.43;95%CI2.5-28.2;P=0.001),Antineoplastic and Immunomodulator Agents (OR=0.49; 95% CI 0.27-0.87; P=0.016), Blood and Blood Forming Organs(OR=0.33;95%CI0.21-0.52;P<0.001), Muscular-Skeletal-System(OR=2.4;95%CI1.13-5.1;P=0.022),Nervous-System(OR=2.75;95%CI1.7-4.4;P<0.001),Respiratory-System (OR=0.38;95%CI0.22-0.67;P=0.001) were associated with the drug discrepancy.

Conclusions:

Medication discrepancies occur commonly on hospital emergency department admission. Understanding the type and frequency of discrepancies can help clinicians better understand ways to prevent them. Structured medication reconciliation process may help to prevent admission medication discrepancies.