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Medication use across transition points from the emergency department: identifying factors associated with medication discrepancies
journal contribution
posted on 2009-11-01, 00:00 authored by Elizabeth ManiasElizabeth Manias, M F Gerdtz, T J Weiland, M CollinsBACKGROUND: As patients move across transition points of care, medication discrepancies are likely to occur. In the emergency department (ED), patients are vulnerable to medication discrepancies because they are in an environment in which rapid decisions need to be made under high levels of stress. OBJECTIVE: To identify the patient-, environment-, and medication-related factors involving unexplained medication discrepancies across transition points after ED presentation. METHODS: Using a retrospective chart review design, a stratified, random sampling of data was undertaken over a 12-month period. Information was obtained from an electronic administrative database and medical records as patients moved from the ED to another transition point of care. Medication discrepancies were classified into 2 outcome groups: (1) no discrepancies and situations in which discrepancies were adequately explained and (2) discrepancies that had no adequate explanation. RESULTS: For the 12-month period, 210 randomly selected patients were included; 73 (34.8%) had at least one unexplained medication discrepancy. Binary logistic regression modeling showed 4 factors that were statistically significant in determining the incidence of at least one unexplained medication discrepancy. Benefit card holders (individuals who receive benefits from government insurance programs comparable to the US-based Medicare and Medicaid initiatives, which include the elderly, the disabled, low income earners, and unemployed persons) had 3.73 greater odds of experiencing an unexplained medication discrepancy (95% CI 1.72 to 8.07; p = 0.001). Patients prescribed 5 or more drugs at discharge from the ED had 12.22 greater odds of having at least one unexplained medication discrepancy (95% CI 5.52 to 27.08; p < 0.001). Patients who were first seen by a physician within 1 hour of a change in working shift had 3.70 greater odds of having an unexplained medication discrepancy (95% CI 1.67 to 8.18; p = 0.001). For each additional minute of wait time for a physician, the odds of having an unexplained medication discrepancy increased by a factor of 1.01 (95% CI 1.00 to 1.01; p = 0.042). CONCLUSIONS: Patient-, environment-, and drug-related factors contribute to the risk of medication discrepancies across transition points from the ED.
History
Journal
Annals of pharmacotherapyVolume
43Issue
11Pagination
1755 - 1764Publisher
SAGE PublicationsLocation
London, Eng.Publisher DOI
ISSN
1060-0280eISSN
1542-6270Language
engPublication classification
C1.1 Refereed article in a scholarly journalCopyright notice
2009, [SAGE Publications]Usage metrics
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AdolescentAdultAgedAged, 80 and overContinuity of Patient CareDatabases, FactualEmergency Service, HospitalFemaleHumansMaleMedication ErrorsMiddle AgedRetrospective StudiesYoung Adultcare transitioncommun icationemergency departmentmedication discrepancymedication reconciliationScience & TechnologyLife Sciences & BiomedicinePharmacology & PharmacycommunicationHOSPITAL ADMISSIONRECONCILIATIONHISTORIESERRORTIME
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