Unintended Medication Discrepancies Associated with Reliance: DISCUSSION
Medication errors are a major source of in-hospital adverse events, and strategies to reduce these potentially avoidable errors are needed. Although the use of a province-wide prescription database is widely assumed to reduce hospital medication-ordering errors, this strategy had not previously been evaluated. In this pilot study, despite use of the PharmaNet database at the time admission orders were prepared, the proportion of patients with unintended medication discrepancies remained high, and a substantial proportion of the discrepancies were classified as having potential for moderate or severe patient discomfort or clinical deterioration. In a similar study in Ontario, where a provincial prescription database was not available, the proportion of patients with unintended discrepancies was similar (54% versus 60% in the current study), as was the level of potential harm associated with the discrepancies identified. Although the rate of omission errors in the current study was slightly lower than in the Ontario study (37% versus 46%), this benefit was offset by a higher rate of errors of commission (27% versus 0%).
The findings in this study highlight the limitations of relying on a province-wide prescription database to improve the accuracy of admission medication histories. Similarly, a recent study examining agreement between information in the PharmaNet profile and an interview-based BPMH reported PharmaNet inaccuracies for 71% of the study population. The discrepancies in that study were related to the type and number of medications taken by the patient and the doses of individual medications consumed. Medications are only recorded in the PharmaNet profile at the time they are dispensed, and discrepancies may arise when doses are changed or medications are discontinued between refills. As well, late refills can give the impression that a patient no longer uses a particular medication. In the aforementioned study, late refills were the most common source of PharmaNet discrepancies. buy cialis soft tabs
Misconceptions regarding the scope of the PharmaNet profile may also be a concern, as some practitioners may be unaware that some medications are not recorded in the profile (e.g., no antiretro- virals and few nonprescription medications). In the current study, admission medication histories recorded in the chart were commonly inaccurate, even though PharmaNet was used in almost all cases. In addition, the PharmaNet profiles did not reflect actual medication use for a substantial proportion of patients, and these errors were carried through in the medication ordering. This suggests that PharmaNet may have been used as a substitute for medication history-taking, rather than as an additional resource for medication reconciliation. Educating all practitioners about these limitations will be an important step in encouraging more appropriate use of PharmaNet and similar databases and discouraging their use as sole sources of a medication history.