Medication Reconciliation in a Rural Trauma Population
Presented at the Western Trauma Association annual meeting, February 2007, Steamboat Springs, CO.
Received 12 October 2007; received in revised form 10 December 2007, 15 January 2008, 11 February 2008 and 27 February 2008; accepted 21 March 2008. published online 13 June 2008.
Refers to article:
The Unexpected Challenges of Accurate Medication Reconciliation
, 01 September 2008
Stephen Schenkel
Annals of Emergency Medicine
November 2008 (Vol. 52, Issue 5, Pages 493-495) Full Text |
Full-Text PDF (64 KB)
Study objective
Medication errors during hospitalization can lead to adverse drug events. Because of preoccupation by health care providers with life-threatening injuries, trauma patients may be particularly prone to medication errors. Medication reconciliation on admission can result in decreased medication errors and adverse drug events in this patient population. The purpose of this study is to determine the accuracy of medication histories obtained on trauma patients by initial health care providers compared to a medication reconciliation process by a designated clinical pharmacist after the patient's admission and secondarily to determine whether trauma-associated factors affected medication accuracy.
Methods
This was a prospective enrollment study during 13 months in which trauma patients admitted to a Level I trauma center were enrolled in a stepwise medication reconciliation process by the clinical pharmacist. The setting was a rural Level I trauma center. Patients admitted to the trauma service were studied. The intervention was medication reconciliation by a clinical pharmacist. The main outcome measure was accuracy of medication history by initial trauma health care providers compared to a medication reconciliation process by a clinical pharmacist who compared all sources, including telephone calls to pharmacies. Patients taking no medications (whether correctly identified as such or not) were not analyzed in these results. Variables examined included admission medication list accuracy, age, trauma team activation mode, Injury Severity Score, and Glasgow Coma Scale (GCS) score.
Results
Two hundred thirty-four patients were enrolled. Eighty-four of 234 patients (36%) had an Injury Severity Score greater than 15. Medications were reconciled within an average of 3 days of admission (range 1 to 8) by the clinical pharmacist. Overall, medications as reconciled by the clinical pharmacist were recorded correctly for 15% of patients. Admission trauma team medication lists were inaccurate in 224 of 234 cases (96%). Admitting nurses' lists were more accurate than the trauma team's (11% versus 4%; 95% confidence interval 2.5% to 11.2%). Errors were found by the clinical pharmacist in medication name, strength, route, and frequency. No patients (0/20) with admission GCS less than 13 had accurate medication lists. Seventy of 84 patients (83%) with an Injury Severity Score greater than 15 had inaccurate medication lists. Ten of 234 patients (4%) were ordered wrong medications, and 1 adverse drug event (hypoglycemia) occurred. The median duration of the reconciliation process was 2 days. Only 12% of cases were completed in 1 day, and almost 25% required 3 or more (maximum 8) days.
Conclusion
This study showed that medication history recorded on admission was inaccurate. This patient population overall was susceptible to medication inaccuracies from multiple sources, even with duplication of medication histories by initial health care providers. Medication reconciliation for trauma patients by a clinical pharmacist may improve safety and prevent adverse drug events but did not occur quickly in this setting.
Department of Surgery, Conemaugh Memorial Medical Center, Johnstown, PA
Address for correspondence: S. Lee Miller, MD, FACS, Conemaugh Memorial Medical Center, Trauma Services, 1086 Franklin Street, Johnstown, PA 15905; 814-534-9402, fax 814-534-3178
Supervising editor: Robert L. Wears, MD, MS
Author contributions: SLM was responsible for study conception and design. SLM and TSH interpreted data. SM was responsible for data acquisition. SLM and SM monitored the study. JB assimilated data and conducted data analysis and critical review of article. TSH was responsible for drafting and revision of the article. TSH takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.
ABSTRACT