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01-11-2012 | Legal medicine | Article

Electronic health records do not rule out medication errors


Free abstract

medwireNews: Relying on electronic health records (EHRs) is not enough to ensure accurate and complete documentation of patient medications, show study results, suggesting that efforts to minimize medication discrepancies are needed.

The findings indicate a medication discrepancy rate of over 50% in a population of ambulatory care patients treated between April 2010 and July 2011 by the Veterans Affairs (VA) Boston Healthcare System in the USA.

More importantly, note the researchers, almost a third of patients reported taking one or more medications that did not appear on the "active" medication list.

"Discrepancies have been associated with ADEs [adverse drug events], which lead to increases in healthcare utilisation, costs, and morbidity," write Amy Linsky (VA Boston Healthcare System, Massachusetts) and colleagues in the BMJ Quality and Safety.

"Providers must be cognisant of these issues and continue to perform detailed medication review and reconciliation with their patients."

The study compared 104 patients' self-reported medications with their EHR records, noting: commissions ‑ medications listed as active in the EHR but the patient did not report using them; omissions ‑ medications that the patient reported using but were not recorded in the EHR; duplication ‑ more than one active listing for the same medication or drug class for a patient; and alteration in dose or frequency ‑ when a patient reported taking medication at a different dose or frequency to that stated in the EHR.

Overall, 60% of the cohort had a discrepancy that fit at least one of these criteria, with a mean discrepancy rate of 3.7 per patient. Discrepancies broke down into 36% commissions, 27% omissions, 11% duplications, and 19% alterations in dose or frequency.

The discrepancy in commissions "could lead to unnecessary alerts for drug‑drug interactions, adding to known concerns with alert fatigue," note the authors, adding that it may also contribute to polypharmacy if a clinician initiates another medication.

In multivariate analysis, an increasing number of medications was associated with a greater number of commissions and duplications, each with odds ratios (ORs) of 1.2 per medication. Conversely, increasing medications was associated with fewer omissions, with an OR of 0.9.

Approaches to improve medication reconciliation could include health information technology-related interventions "such as use of clinical decision support systems that flag medications without an appropriate indication on the problem list," concludes the research team.

By Sarah Guy, medwireNews Reporter

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