Clinical Relevance of Prescription Omissions and Dosing Inconsistencies in Patients Transferred Between Emergencyand Inpatient Care
DOI:
https://doi.org/10.66892/CJMHP/V4I2/4.2.02Keywords:
Prescription Omissions, Dosing Inconsistencies, Medication Reconciliation, Transitions of Care, Emergency Department, Inpatient Care, Patient Safety.Abstract
Transition from the emergency department to the inpatient unit is a risky process where prescriptions can get overlooked or changed unintentionally; however, the clinical significance of such discrepancies has been inadequately described. The aim of the current research was to establish how often and clinically significant were medication omission and dosage differences in transferred patients. The novelty of this research is that both types of discrepancies were scored together with regard to the potential harm and connected with short-term outcomes. This was a retrospective, hospital-based, cross-sectional analytical
study of 312 adult patients transferred from the emergency department to medical and surgical units of the tertiary teaching hospital. Medication history, verified by pharmacists, was compared with prescriptions of the emergency department and inpatient orders made within 24 hours after admission to the ward, and discrepancies were scored with respect to their potential harm by a clinical panel. Chisquare and multivariate logistic regression analyses were conducted in SPSS version 27. At least one unintentional discrepancy was detected in 189 out of 311 patients (60.6%), including 412 discrepancies, with 264 (64.1%) being medication omissions and 148 (35.9%) being dosing issues. A total of 241 discrepancies (58.5%) were categorized as moderate or major, and 134 patients (42.9%) had at least one clinically significant discrepancy. The independent risk factors for clinically significant discrepancies were polypharmacy (adjusted OR = 2.93; 95% CI: 1.71–5.02) and no pharmacist reconciliation in the emergency department (adjusted OR = 2.41; 95% CI: 1.43–4.06). Clinically significant discrepancies were found to be linked with clinical instability during the first 72 hours (adjusted OR = 3.12; 95% CI: 1.52–6.40) and a longer hospitalization (7.9 ± 3.6 days compared to 5.6 ± 2.9 days; p < 0.001).
