Primary care doctors should help patients keep med lists current

Presenting a physician-validated medication list upon hospital admission significantly protects against medication errors, said researchers who now suggest that primary care physicians should help patients and caregivers maintain, review and update their lists.

Pharmacists at Northwestern Memorial Hospital in Chicago conducted the study for 14 months in 2006-2007. They retrieved the previous days' admissions and obtained from the electronic medical records the physician-obtained medical history, as well as admission medication orders and patient demographics for 651 adult inpatients with 5,701 prescriptions.

The pharmacists then interviewed the patients, checked their prescription bottles, and consulted with pharmacies to reconcile information and compare it with medication orders to identify unexplained history and order discrepancies. Those resulting in order changes were considered errors, and were classified by drug class, type of error and the potential to cause harm had it not been caught. Findings were published online Feb. 24 by the Journal of General Internal Medicine.

Among the group, 35.9% experienced 309 order errors and 85% had errors originate in medication histories, almost half of which were omissions. Cardiovascular agents were commonly in error (29.1%). If undetected, 52.4% of order errors could have potentially required increased monitoring or intervention to preclude harm and 11.7% were rated as potentially harmful. Factors significantly associated with errors potentially requiring monitoring or causing harm included age older than 65 (odds ratio [OR], 2.17; 95% CI, 1.09 to 4.30) and number of prescription medications (OR, 1.21; 95% CI, 1.14 to 1.29). Presenting a medication list (OR, 0.35; 95% CI, 0.19 to 0.63) or prescription bottles (OR, 0.55; 95% CI, 0.27 to 1.10) at admission helped.

Researchers wrote that attempts to improve the accuracy of medication histories should focus on older patients with a large number of medications, and that primary care physicians should help patients maintain complete, accurate and understandable medication lists.

Unexplained discrepancies occurred even though the researchers and the prescribing physician used the same medication lists or bottles. Researchers attributed this to physicians copying lists or prescription labels verbatim without systematically reviewing each medication. This step is important, they said, because labels on prescription bottles may not accurately reflect current regimens, newly prescribed medications or recent changes. A medication reconciliation toolkit is online.