Medication details documented on hospital discharge: cross-sectional observational study of factors associated with medication non-reconciliation.

AIMS: Movement into or out of hospital is a vulnerable period for medication safety. Reconciling the medication a patient is using before admission with the medication prescribed on discharge, and documenting any changes (medication reconciliation) is recommended to improve safety. The aims of the study were to investigate the factors contributing to medication reconciliation on discharge, and identify the prevalence of non-reconciliation. METHODS: The study was a cross-sectional, observational survey using consecutive discharges from purposively selected services in two acute public hospitals in Ireland. Medication reconciliation, potential for harm and unplanned re-admission were investigated. RESULTS: Medication non-reconciliation was identified in 50% of 1245 inpatient episodes, involving 16% of 9569 medications. The majority of non-reconciled episodes had potential to result in moderate (63%) or severe (2%) harm. Handwritten rather than computerized discharges (adjusted odds ratio (adjusted OR) 1.60, 95% CI 1.11, 2.99), increasing number of medications (adjusted OR 1.26, 95% CI 1.21, 1.31) or chronic illness (adjusted OR 2.08, 95% CI 1.33, 3.24) were associated with non-reconciliation. Omission of endocrine, central nervous system and nutrition and blood drugs was more likely on discharge, whilst omission on admission and throughout inpatient care, without documentation, was more likely for obstetric, gynaecology and urinary tract (OGU) or respiratory drugs. Documentation in the discharge communication that medication was intentionally stopped during inpatient care was less likely for cardiovascular, musculoskeletal and OGU drugs. Errors involving the dose were most likely for respiratory drugs. CONCLUSIONS: The findings inform strategies to facilitate medication reconciliation on discharge from acute hospital care.

Cross-cultural validation of the desire for information about prescribed medicines scale.

OBJECTIVES: It is the overall aim of this study to validate an existing scale to measure patients' desire for information about their medicines in the geographically and culturally disparate context of the USA. Specific objectives are to determine the psychometric properties of the previously validated Extent of Information Desired (EID) and Perceived Utility of Medicines (PUM) scales and to describe the complexities inherent to cross-cultural validation. METHODS: The setting was a culturally diverse tri-county (Palm Beach, Broward and Miami Dade counties) area of South Florida. The research design was cross-sectional and descriptive; data were gathered from respondents using a facilitator-administered survey instrument. KEY FINDINGS: The overall reliability of the survey was 0.669 using Cronbach's alpha. When EID and PUM survey statements were analysed alone, internal consistency was 0.692 and 0.545 respectively. The association between scores and select demographic variables were analysed and no correlation was found. The previously validated scale (UK) was not reliable in the complex cultural population of Florida. CONCLUSIONS: Instruments demonstrating reliability in one country are not immediately replicable in other countries, even if the same language is spoken. Caution needs to be taken when interpreting the findings from studies using instruments designed in cultural contexts dissimilar from those in which the have been developed originally.