Medication discrepancies and associated risk factors identified among elderly patients discharged from a tertiary hospital in Singapore

<p><b>INTRODUCTION</b>Medication discrepancies and poor documentation of medication changes (e.g. lack of justification for medication change) in physician discharge summaries can lead to preventable medication errors and adverse outcomes. This study aimed to identify and characterise discrepancies between preadmission and discharge medication lists, to identify associated risk factors, and in cases of intentional medication discrepancies, to determine the adequacy of the physician discharge summaries in documenting reasons for the changes.</p><p><b>METHODS</b>A retrospective clinical record review of 150 consecutive elderly patients was done to estimate the number of medication discrepancies between preadmission and discharge medication lists. The two lists were compared for discrepancies (addition, omission or duplication of medications, and/or a change in dosage, frequency or formulation of medication). The patients' clinical records and physician discharge summaries were reviewed to determine whether the discrepancies found were intentional or unintentional. Physician discharge summaries were reviewed to determine if the physicians endorsed and documented reasons for all intentional medication changes.</p><p><b>RESULTS</b>A total of 279 medication discrepancies were identified, of which 42 were unintentional medication discrepancies (35 were related to omission/addition of a medication and seven were related to a change in medication dosage/frequency) and 237 were documented intentional discrepancies. Omission of the baseline medication was the most common unintentional discrepancy. No reasons were provided in the physician discharge summaries for 54 (22.8%) of the intentional discrepancies.</p><p><b>CONCLUSION</b>Unintentional medication discrepancies are a common occurrence at hospital discharge. Physician discharge summaries often do not have adequate information on the reasons for medication changes.</p>

Reliability and Validity Evaluation of Modified Medication Discrepancy Tool / 中国药房

OBJECTIVE:To evaluate the content validity and interrater reliability of the modified medication discrepancy tool (MDT). METHODS:According to the structure of MDT(English edition),the terms of MDT were modified,and 5 invited ex-perts used content validity indicator to test the content validity of MDT. The interrater reliability method was adopted to test the reli-ability of MDT. The interrater reliability was performed by 2 evaluators to same 20 research objects with modified MDT. RE-SULTS:Average item-level content validity index was over 0.800,and scale-level content validity index was 0.970. The item-level interrater reliability was between 0.667 and 1.000(P<0.01). The scale-level interrater reliability was 0.840(P<0.01). CONCLU-SIONS:The modified MDT has good content validity and interrater reliability,and can be used to evaluate discharged medication discrepancies in China.