The effect of medication reconciliation in elderly

Authors: Patrik Midlöv Leila Bahrani Mehran Seyfali Peter Höglund Eva Rickhag Tommy Eriksson

Publish Date: 2011/12/30

Volume: 34, Issue: 1, Pages: 113-119

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Abstract

Objective To assess the impact of medication reconciliation interventions on medication error rates when elderly patients are discharged from hospital to community care or nursing homesSetting Elderly patients 65 years living in nursing homes or in their own homes with care provided by the community nursing system Method All medical records containing information on drug treatment were collected from hospital departments the community care service and GPs We then identified if there were any changes in the transfer of information ie if the drugs were not the same as before the transfer Two different persons independently evaluated all information about the patients’ drugs to identify medication errors for three different time periods During all three periods structured discharge information was used In period 2 electronic medication lists were introduced and in period 3 we introduced specific routines and support by a clinical pharmacist to ensure prescription in the specific medication dispensing system ApoDos Asymptotic Linear by–Linear Association Test was used to compare number of medication errors in period 1 2 and 3 respectively Main outcome measure Number of medication errors per patient Results A total of 123 patients were evaluated at discharge For the 109 patients using the ApoDos system there were significant differences in the number of medication errors between period 1 and 3 P = 0048 period 2 and 3 P = 0037 but not between period 1 and 2 P = 041 The mean numbers of errors were 15 11 and 05 for period 1 2 and 3 respectively The 14 patients not using the ApoDos system had on average 04 errors per patient Among the 58 patients with medication errors 34 were evaluated as having low clinical risk 22 moderate and 2 high clinical risk Conclusion Medication errors are still common when elderly patients are transferred from hospital to community/primary care The main risk factor seems to be the specific medication dispensing system ApoDos or rather the process on how to use it When this system was supported by clinical pharmacists the error rate dropped to the same level as for patients without ApoDos

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