Unintended Medication Discrepancies Associated with Reliance: DISCUSSION part 2
Practitioners should also be educated about the importance of routinely collecting information for nonprescription products. Although a perception may exist that nonprescrip- tion medications are a relatively low priority in the context of a hospital admission, 7 (35%) of the patients in this study had an admission order discrepancy associated with a nonprescription medication, and 23% of these discrepancies were judged to have potential for a severe adverse outcome. Many of these discrepancies occurred because the patient was simply not asked about nonprescription medication use. Even if nonpre- scription medications are intentionally discontinued upon admission to hospital, information about their use is important. For example, it may give insight into possible drug interactions and adverse effects experienced on admission or even after discharge.
This study had several limitations, including the small sample size. Although the study was underpowered to allow statistical comparisons with the Ontario study, it nevertheless revealed a high proportion of medication errors despite use of a province-wide prescription database. Furthermore, the 3-point scoring system used to evaluate the severity of each discrepancy has not been validated, and it is unknown whether the unintended discrepancies actually resulted in adverse events for the patients. However, this scoring system has been used in other studies, and in the current study there was moderate agreement among the physician auditors who quantified the severity of unintended discrepancies. This study included no patients with language or communication barriers or cognitive impairments; as such, the results may not be generalizable to these patient populations, in whom the risk of medication errors may be higher. Furthermore, the patients who were willing to participate in this study may have been more likely to communicate openly with their health care providers, which would improve the chances that the medication history would be accurate. Finally, this study focused on patients in a general medicine ward who were taking at least 4 regular prescription medications before admission and who had unplanned hospital admissions through the emergency department. As such, the discrepancy rates observed might not be representative of those in other medical services or at other facilities using different admission processes. viagra 50 mg
The findings of this investigation suggest that despite frequent use of PharmaNet to aid in history-taking, the admission order discrepancy rates in the study population were high and no better than those observed in a similar population where a prescription database was not available. The perceived severity of the discrepancies was also no different than in the comparison population. Although PharmaNet can be a useful tool in the collection of a thorough medication history, its use as a perceived “best source” of information may increase the risk of unintended order discrepancies on hospital admission, possibly leading to preventable medication errors. Using PharmaNet information to guide the collection of an interview-based BPMH and ensuring the collection of information pertaining to nonprescription medication use are likely the best approaches to ensuring an accurate medication history and minimizing medication errors. Health care providers should be aware of the limitations of pharmacy databases such as PharmaNet. The development of a hospital protocol or tool allowing PharmaNet information to be integrated into a form or order sheet that could be reviewed and confirmed with the patient at the bedside might help practitioners to collect the most accurate history possible in an efficient manner and could be an area of future study.