Background and Objective: 

Medication discrepancies (MD) are common at transition periods such as hospital admission, transfer to another care unit and discharge. These discrepancies can lead to medication errors or other drug related problems, and have the potential to cause harm to the patient. The aim of this study was to investigate the incidence and the type of MD that affect patients who were admitted to the emergency department (ED).

Design: 

Observational, prospective cohort study. At hospital admission, the medication history was structurally documented by a senior year pharmacy student. This list was compared to the physician-acquired medication history and investigated for discrepancies in acute and chronic medications. When patients were transferred from the ED to another ward, the focus was on discrepancies in chronic drugs.

Setting: 

The urgent care facility of the ED of a Belgian university hospital (UZ Brussel).

Main outcome measures: 

The percentage of patients with unintended MD and incidence & type of MD.

Results: 

The study group consisted of 86 patients of which 68 took acute medication and 56 took chronic medication; 38 patients took both acute and chronic medication. For the acute medication group, the pharmacist (median 2, range 0-5) found more home medications per patient than documented by the physician (median 1, range 0-5; p<0,001) and 81% of patients had MD with a median of 1 MD per patient (range 0-7). MD were present with 87% of acute drugs (n=121). For acute medication the most common MD was omission of an acute drug (49% of MD). For the chronic medication group, the pharmacist also found more chronic home medications per patient (median 4, range 0-15) than documented by the physician (median 3, range 0-13; p=0,001) and 98% of patients had MD with a median of 3 MD per patient (range 0-15). One or more MD were present with 72% of chronic drugs (n=244). The most common MD for chronic medication was absence of documenting the frequency of administration (43% of MD). Of the 86 initial patients, 29 were transferred to another care unit; 24 of them took chronic medication. Of the 24 patients, 14 (58%) had one or more MD in their prescribed chronic medication. In total, 35 MD were detected with a median of 1.5 MD per patient (range 0–4). MD were present with 27% of the chronic drugs (n=129). The most common MD was omission of chronic medication (74%).

Conclusions: 

The high number of MD emphasizes the importance of accurate and complete medication histories acquired by structural interviews at the time of ED admission. These medication histories should also include acute drugs because they, as well as chronic drugs may have triggered the ED visit. At the time of transfer to another care unit, the prescribed medication should be reconciled with respect to the original home medication.