Drug record discrepancies in an outpatient electronic medical record: frequency, type, and potential impact on patient care at a hemodialysis center

Pharmacotherapy. 2003 Feb;23(2):231-9. doi: 10.1592/phco.23.2.231.32079.

Abstract

Background: Patients who require hemodialysis take many drugs. Electronic drug records may be discrepant with what patients are actually taking. Record discrepancies are a potential source of drug-related problems. We sought to determine the extent to which drug record discrepancies occur in a hemodialysis population.

Methods: This was a prospective observational study of patients enrolled in a pharmacist clinic at an outpatient hemodialysis center from August-December 2001. Patients participated in monthly drug interviews conducted by a pharmacist, during which patient drug use was determined. Data collected consisted of patient demographics, drug type, and number of drugs. Drug record discrepancies were classified and assigned a potential drug-related problem. Results were compared with the electronic drug record. Patients with documented drug record discrepancies were compared with those patients for whom no discrepancy was identified.

Results: Over the 5-month period, 215 drug interviews were conducted in 63 patients. One hundred thirteen drug record discrepancies were identified in 38 patients (60%). Discrepancies (mean +/- SD 1.7 +/- 1.3, range 1-7) were identified during 65 drug interviews (30.2%). Electronic drug records were discrepant by one drug record, two drug records, and more than two drug records 60.0%, 26.2%, and 13.8% of the time, respectively. Drug record discrepancies placed patients at risk for adverse drug events and dosing errors in 49.6% and 34.5%, respectively, of 113 discrepancies. Patient age negatively correlated with the number of drug record discrepancies identified (r = -0.27, p = 0.04).

Conclusions: Drug record discrepancies occur frequently among patients undergoing hemodialysis. Incorporation of a pharmacist into the patient care team may increase the accuracy of the electronic drug record and avert unnecessary drug-related problems.

MeSH terms

  • Ambulatory Care
  • Drug Interactions
  • Drug Utilization Review
  • Female
  • Humans
  • Interviews as Topic
  • Male
  • Medical Records Systems, Computerized / standards*
  • Medication Errors / statistics & numerical data
  • Middle Aged
  • Missouri
  • Outcome Assessment, Health Care*
  • Pharmaceutical Preparations / administration & dosage
  • Prospective Studies
  • Renal Dialysis*
  • Self Administration / statistics & numerical data*

Substances

  • Pharmaceutical Preparations