Medication Discrepancies in Transferring T2DM Patients
Medication Discrepancies in Transferring T2DM Patients
Objective. To identify, classify and determine the factors associated with medication discrepancies for type 2 diabetes mellitus (T2DM) patients, referred from primary care to a tertiary ambulatory clinic.
Design. Retrospective audit of outpatient clinic records.
Setting. Royal Prince Alfred Hospital (RPAH) Diabetes Ambulatory Care Centre.
Participants. 300 randomly selected adult T2DM patients who attended the Diabetes Centre between 01 January 2010 and 31 December 2011.
Main Outcome Measures. The rates and types of medication discrepancies were identified by comparing the structured nurse–patient interview (SNPI) with the primary care [General Practitioner (GP)] referral letter, where the SNPI was considered the best possible medication history. Discrepancies were identified as addition, omission, dose and insulin-type discrepancies. Each category was mutually exclusive.
Results. Over 80% of referral letters contained at least one discrepancy with a median of two discrepancies per referral. Of a total of 744 discrepancies, the majority were omissions (58.9%). Insulins had the highest discrepancy rate. Factors independently associated with medication discrepancies were GP referral letter type, total number of medications and medication regimen type.
Conclusions. A high rate of medication discrepancies was found in GP referral letters for patients referred to this clinic. Automated GP referral letters and inaccurate GP records may have contributed to this, highlighting the need for routine medication reconciliation at transitions of care, to ensure prescribers have access to correct medication information to inform decision-making and ensure optimal patient outcomes.
Patient transitions from one interface of health care to another often result in changes to medication regimen; medications may be withheld, new medications added or chronic medications changed. In the absence of accurate documentation and/or communication of information from one location of care to another, medication discrepancies (i.e. inconsistencies) between medication lists may occur. This has implications for patient safety as estimates suggest that 30% of discrepancies have the potential to cause patient harm and the greater the number of discrepancies, the greater the potential to cause patient harm.
In recent literature, there has been a major focus on identification, reconciliation and rectification of medication discrepancies at transitions in health care, with most studies exploring transitions associated with hospitalization including hospital admission, transfer between units and discharge. Medication discrepancies may occur at each of these transitions. The most frequent types of medication discrepancies common to all three interfaces of care are omission or addition of a medication to the patient's medical record. Research has shown that between 10 and 61% of medication histories taken on hospital admission contain at least one omission error and 13–22% at least one addition of a drug not used before admission.
However, studies examining medication discrepancies on transitions from primary care to specialty outpatient clinics are limited. The exception was a study by Carney who found that the overall medication regimen accuracy rate of GP referral letters for 46 new patients referred to a general nephrology/hypertension outpatients' clinic in Newcastle, NSW, was 58%. A number of patient factors have been shown to be associated with medication discrepancies, including age and number of medications; however, other factors may increase the risk depending on the setting. Use of handwritten referrals and GP characteristics may also influence the accuracy of referral medication lists.
As type 2 diabetes mellitus (T2DM) is a chronic, progressive disease, its management commonly involves multiple levels of care. For these patients, the more common transitions are between outpatient clinicians and primary care as this model represents contemporary best practice management. Since patients are typically prescribed multiple medications to manage glycaemia and cardiovascular risk factors, any medication discrepancies at each care transition may pose a significant safety risk to the patient. Understanding the nature, extent and risk factors associated with medication discrepancies at transitions within outpatients setting is critical to optimal T2DM management.
The aim of this study was to identify the prevalence of medication discrepancies and to classify them in T2DM patients who transition between general practice and tertiary ambulatory diabetes care. A secondary objective was to identify risk factors associated with medication discrepancies.
Abstract and Introduction
Abstract
Objective. To identify, classify and determine the factors associated with medication discrepancies for type 2 diabetes mellitus (T2DM) patients, referred from primary care to a tertiary ambulatory clinic.
Design. Retrospective audit of outpatient clinic records.
Setting. Royal Prince Alfred Hospital (RPAH) Diabetes Ambulatory Care Centre.
Participants. 300 randomly selected adult T2DM patients who attended the Diabetes Centre between 01 January 2010 and 31 December 2011.
Main Outcome Measures. The rates and types of medication discrepancies were identified by comparing the structured nurse–patient interview (SNPI) with the primary care [General Practitioner (GP)] referral letter, where the SNPI was considered the best possible medication history. Discrepancies were identified as addition, omission, dose and insulin-type discrepancies. Each category was mutually exclusive.
Results. Over 80% of referral letters contained at least one discrepancy with a median of two discrepancies per referral. Of a total of 744 discrepancies, the majority were omissions (58.9%). Insulins had the highest discrepancy rate. Factors independently associated with medication discrepancies were GP referral letter type, total number of medications and medication regimen type.
Conclusions. A high rate of medication discrepancies was found in GP referral letters for patients referred to this clinic. Automated GP referral letters and inaccurate GP records may have contributed to this, highlighting the need for routine medication reconciliation at transitions of care, to ensure prescribers have access to correct medication information to inform decision-making and ensure optimal patient outcomes.
Introduction
Patient transitions from one interface of health care to another often result in changes to medication regimen; medications may be withheld, new medications added or chronic medications changed. In the absence of accurate documentation and/or communication of information from one location of care to another, medication discrepancies (i.e. inconsistencies) between medication lists may occur. This has implications for patient safety as estimates suggest that 30% of discrepancies have the potential to cause patient harm and the greater the number of discrepancies, the greater the potential to cause patient harm.
In recent literature, there has been a major focus on identification, reconciliation and rectification of medication discrepancies at transitions in health care, with most studies exploring transitions associated with hospitalization including hospital admission, transfer between units and discharge. Medication discrepancies may occur at each of these transitions. The most frequent types of medication discrepancies common to all three interfaces of care are omission or addition of a medication to the patient's medical record. Research has shown that between 10 and 61% of medication histories taken on hospital admission contain at least one omission error and 13–22% at least one addition of a drug not used before admission.
However, studies examining medication discrepancies on transitions from primary care to specialty outpatient clinics are limited. The exception was a study by Carney who found that the overall medication regimen accuracy rate of GP referral letters for 46 new patients referred to a general nephrology/hypertension outpatients' clinic in Newcastle, NSW, was 58%. A number of patient factors have been shown to be associated with medication discrepancies, including age and number of medications; however, other factors may increase the risk depending on the setting. Use of handwritten referrals and GP characteristics may also influence the accuracy of referral medication lists.
As type 2 diabetes mellitus (T2DM) is a chronic, progressive disease, its management commonly involves multiple levels of care. For these patients, the more common transitions are between outpatient clinicians and primary care as this model represents contemporary best practice management. Since patients are typically prescribed multiple medications to manage glycaemia and cardiovascular risk factors, any medication discrepancies at each care transition may pose a significant safety risk to the patient. Understanding the nature, extent and risk factors associated with medication discrepancies at transitions within outpatients setting is critical to optimal T2DM management.
The aim of this study was to identify the prevalence of medication discrepancies and to classify them in T2DM patients who transition between general practice and tertiary ambulatory diabetes care. A secondary objective was to identify risk factors associated with medication discrepancies.
Source...