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Hospital Patients May Be in Danger of Breakdowns in Medication Reconciliation

Galvin B. Kennedy
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Partner at Kennedy Hodges LLP practicing personal injury, pharmacy error, and overtime law

When people arrive at hospitals, it is assumed that they will receive help and the proper care they need to make a full recovery. However, there are errors that occur at hospitals that can put patients in harm. While most people are familiar with the major mistakes of wrong site surgery and receiving too high of a dose of medication, minor mistakes can also be damaging. In fact, something minor during the admission process could potentially cause major harm.

According to the Pennsylvania Patient Safety Authority, analysts looked at data from November 1, 2011 through November 31, 2012, and found many reports of breakdowns in medication reconciliation. In fact, 501 reports showed breakdowns in the medication reconciliation process, especially during admission. “Medication  reconciliation is the process of comparing the list of medications a patient is taking while at home with newly ordered medications in the hospital to identify and resolve any differences in medications,” said Mike Gaunt, PharmD, patient safety analyst for the Pennsylvania Patient Safety Authority.

The study revealed the breakdowns in medication reconciliation as follows:

  • Nearly 70 percent occurred during admission
  • About 40 percent took place during prescribing
  • About 27 percent occurred during transcribing
  • Nearly 10 percent happened during discharge
  • About 8.6 percent occurred during patient transfer

Although there were 501 recorded events of medication reconciliation breakdowns, only 18 patients were harmed as a result. However, even 18 people is one too many patients who needlessly suffered. Everyone involved in the process should take the necessary time to find out what medications patients are taking when they arrive at hospitals. Additionally, it is important that patients keep an accurate list of their medications with them to prevent a medication error during admission.

While missing information on the part of patients can be dangerous, providers are responsible for wrong dosages and poor transcription efforts. In fact, the analysis of the 501 reports revealed the most frequent breakdown involved missing a drug or medication dose, followed by patients receiving an incorrect medication or dosage.

This report should not only warn healthcare workers about the dangers involved in prescribing and administering medications, but hospital patients should be aware of the dangers involved with medication reconciliation upon admission. Unfortunately, providers might overlook a medication a patient is currently taking upon admission, which could lead to any of the following medical mistakes:

  • Drug interactions
  • Overdoses
  • Patient harm

Help others avoid a medication error upon admission by sharing this article with your friends and family.