Accuracy of medication reconciliation: Does physician experience playarole?
Estrada K, Henkin DR, and Kohal TM. Accuracy of medication reconciliation: Does physician experience playarole? J Gen Intern Med 2018; 33(2):104.
J Gen Intern Med
Background: Lack of fidelity in medication reconciliation is a known issue in healthcare systems. Previous studies suggest medication reconciliation error rates as high as 41%.1 It is important to recognize and establish the prevalence of errors related to medication reconciliation to prevent morbidity and mortality. Vargas et al found that physician experience was a risk factor for medication reconciliation errors. This study found that the resident service had more medication reconciliation errors than senior physicians.2 This is corroborated in a systematic review from 2017, which also identified experience of the admitting physician as a risk factor for error.3 We hypothesized that in a 877-bed tertiary care teaching facility there is a high prevalence of error in medication reconciliation, and we expected the teaching service to have a higher rate of errors compared to fully trained physicians. 1 Mazhar F., Akram S., Al-Osaimi Y.A., Haider N. Medication reconciliation errors in a tertiary care hospital in Saudi Arabia: admission discrepancies and risk factors. Pharmacy Practice 2017 Jan-Mar: 15(1):86 2 Rodrí guez vargas B, Delgado silveira E, Iglesias peinado I, Bermejo vicedo T. Prevalence and risk factors for medication reconciliation errors during hospital admission in elderly patients. Int J Clin Pharm. 2016; 38(5):1164-71. 3 Hias J, Van der linden L, Spriet I, et al. Predictors for unintentional medication reconciliation discrepancies in pread-mission medication: a systematic review. Eur J Clin Pharmacol. 2017; 73(11):1355-1377. Methods: Medication reconciliation was assessed on both a resident and senior hospitalist run in-patient service. 100 patients from each service were included. Data was collected by individual patient interviews. This consisted of verbally consenting patients for enrollment in the study followed by a medication-oriented interview. Patients were asked if they knew which medications they were taking, as well as dosages and frequency. If patients were uncertain of their medications, their caregivers, family, and pharmacies were contacted to verify their medications, which was also documented. Data was collected on number of omissions, commissions, and dose changes in each medication list. A two sample t-test was used to evaluate the errors in reconciliation including omission, commission, and dosages between the hospitalist and resident run services. Results: Overall 71.5% of patients in both groups had errors in medication reconciliation. When comparing the hospitalist and teaching service, there was no statistical significance in medication omissions (p = 0.85), commissions (p = 0.40) and doses (p = 0.14). Conclusions: In our study, we did find significant ratesof error, however, we did not find a difference in the frequency of errors between a resident teaching service and hospitalist service at a 877 bed tertiary care center. This suggests that there are system-wide factors that contribute to poor medication reconciliation and further investigation is warranted.