TY - JOUR

T1 - Medicines Reconciliation in the Emergency Department

T2 - Important Prescribing Discrepancies between the Shared Medication Record and Patients’ Actual Use of Medication

AU - Andersen, Tanja Stenholdt

AU - Gemmer, Mia Nimb

AU - Sejberg, Hayley Rose Constance

AU - Jørgensen, Lillian Mørch

AU - Kallemose, Thomas

AU - Andersen, Ove

AU - Iversen, Esben

AU - Houlind, Morten Baltzer

N1 - Funding Information: Funding: M.B.H. was supported by a postdoctoral fellowship from The Capital Region’s Research Foundation for Health Research, Denmark (grant-A6882). Funding Information: M.B.H. was supported by a postdoctoral fellowship from The Capital Region?s Research Foundation for Health Research, Denmark (grant-A6882). Acknowledgments: This study was performed as part of the Clinical Academic Group (ACUTE-CAG) for Recovery Capacity nominated by the Greater Copenhagen Health Science Partners (GCHSP). Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

PY - 2022

Y1 - 2022

N2 - Medication reconciliation is crucial to prevent medication errors. In Denmark, primary and secondary care physicians can prescribe medication in the same electronic prescribing system known as the Shared Medication Record (SMR). However, the SMR is not always updated by physicians, which can lead to discrepancies between the SMR and patients’ actual use of medication. These discrepancies may compromise patient safety upon admission to the emergency department (ED). Here, we investigated (a) the occurrence of discrepancies, (b) factors associated with discrepancies, and (c) the percentage of patients accessible to a clinical pharmacist during pharmacy working hours. The study included all patients age ≥ 18 years who were admitted to the Hvidovre Hospital ED on three consecutive days in June 2020. The clinical pharmacists performed medicines reconciliation to identify prescribing discrepancies. In total, 100 patients (52% male; median age 66.5 years) were included. The patients had a median of 10 [IQR 7–13] medications listed in the SMR and a median of two [IQR 1–3.25] discrepancies. Factors associated with increased rate of prescribing discrepancies were age < 65 years, time since last update of the SMR ≥ 115 days, and patients’ self-dispensing their medications. Eighty-four percent of patients were available for medicines reconciliations during the normal working hours of the clinical pharmacist. In conclusion, we found that discrepancies between the SMR and patients’ actual medication use upon admission to the ED are frequent, and we identified several risk factors associated with the increased rate of discrepancies.

AB - Medication reconciliation is crucial to prevent medication errors. In Denmark, primary and secondary care physicians can prescribe medication in the same electronic prescribing system known as the Shared Medication Record (SMR). However, the SMR is not always updated by physicians, which can lead to discrepancies between the SMR and patients’ actual use of medication. These discrepancies may compromise patient safety upon admission to the emergency department (ED). Here, we investigated (a) the occurrence of discrepancies, (b) factors associated with discrepancies, and (c) the percentage of patients accessible to a clinical pharmacist during pharmacy working hours. The study included all patients age ≥ 18 years who were admitted to the Hvidovre Hospital ED on three consecutive days in June 2020. The clinical pharmacists performed medicines reconciliation to identify prescribing discrepancies. In total, 100 patients (52% male; median age 66.5 years) were included. The patients had a median of 10 [IQR 7–13] medications listed in the SMR and a median of two [IQR 1–3.25] discrepancies. Factors associated with increased rate of prescribing discrepancies were age < 65 years, time since last update of the SMR ≥ 115 days, and patients’ self-dispensing their medications. Eighty-four percent of patients were available for medicines reconciliations during the normal working hours of the clinical pharmacist. In conclusion, we found that discrepancies between the SMR and patients’ actual medication use upon admission to the ED are frequent, and we identified several risk factors associated with the increased rate of discrepancies.

KW - Clinical pharmacist

KW - Drug information service

KW - Electronic medical record

KW - Electronic prescribing

KW - Emergency department

KW - Hospital pharmacy service

KW - Medication reconciliation

KW - Shared medication record

U2 - 10.3390/ph15020142

DO - 10.3390/ph15020142

M3 - Journal article

C2 - 35215255

AN - SCOPUS:85123900039

VL - 15

JO - Pharmaceuticals

JF - Pharmaceuticals

SN - 1424-8247

IS - 2

M1 - 142

ER -