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>

Exclusive breast feeding; duration at northern areas of Pakistan; a hospital based study

To study the duration and factors influencing exclusive breastfeeding practice. Across sectional descriptive. A primary care hospital Gilgit, northern area of Pakistan. Ten months from March 2007 to December 2007. This study include 125 mothers with mean age of 24.3 years [SD 4.8],37% were illiterate while only 14% were matriculate or above among 125 babies [male 61%: female 39%]. Out of total 125, eighty one [64.8%] babies were exclusively breast fed [EBF] for first six months of life and only five [4%] infants were not given breast milk at all. among 76 male infants, 52 [68.4%] were EBF for six months in comparison to 29 female [59.2%] out of 49. among 36 first born infants only 15 [41.7%] were EBF for six months in comparison to 66 [74.2%] out of 89 not first born [p<0.05]. Exclusive breast feeding for complete 6 months is still not routinely practised by most of mothers and first born are deprived of this right in majority lower socioeconomic group and illiterate mothers are more likelyto breast feed, gender bias was also observed as a significantly high percentage of male babies were observed to be breast fed as compared to females. More efforts are required by health depart. And NGO's to promote good breast feeding practices in our setup