Comparison of hospital admission medication lists with primary care physician and outpatient pharmacy lists

Abstract

Purpose: Medication reconciliation is a process to reduce errors and harm associated with loss of medication information as the patient enters and moves through the healthcare system. This study examines medication list accuracy upon hospital admission.

Design: This prospective study enrolled 75 English-speaking medical and surgical patients (18 years of age or older) who were taking prescription medications. The study took place at a rural, tertiary teaching hospital in the northeastern United States. Data collection occurred from November 2006 to March 2009.

Methods: Nursing admission team medication lists were reconciled with primary care physician (PCP) and outpatient pharmacy (OP) lists. Outcome measures were accuracy of medication history generated by admission nurses (ANs) compared with PCP and OP lists, and identification of factors influencing probability of accurate medication list generation by ANs. The Generalized Estimating Equations modeling approach was used to compare AN, OP, and PCP medication list accuracy. Additionally, sex and age were analyzed as covariates and included in the model.

Findings: Forty-five males and 30 females (N= 75) with a mean age of 60 years (SD 15) participated. Fifty-seven subjects (76%) used over-the-counter or herbal medications, but the AN recorded only 31 (41%) cases. Patients received outpatient care from 1 to 12 providers. Forty patients (67%) obtained medications from one pharmacy, 22 (29%) from two, and 3 (4%) from three pharmacies. OP medication lists were completely accurate more often than PCP but not AN lists (19/75 [25%] OP vs. 6/75 [8%] PCP vs. 14/75 [19%] AN; 95% confidence interval [CI] of the difference [0.07, 0.50]). No difference between AN and PCP list accuracy was found. Completely accurate AN lists were more than twice as likely with male and younger patients (95% CI of the difference [1.07, 6.22] and [0.94, 0.99], respectively).

Conclusions: Like other studies, this study showed admission medication reconciliation lists are often inaccurate. Our results suggest that verification of admission medication lists with outpatient provider lists may improve accuracy. Patients, with guidance from outpatient care providers, should assume accountability for maintaining accurate medication lists. A secure, universal, interactive electronic medical record may be a future solution for organizing and sharing medication data between providers.

Clinical relevance: Medication reconciliation upon inpatient admission remains a high-volume and high-acuity problem. We found that not only hospital medication lists, but source lists, including those maintained by the patient, the PCP, and the OP, are vastly inaccurate.