INCIDENCE OF INADVERTENT MEDICATION RECONCILIATION DISCREPANCIES IN TRAUMA PATIENTS

Objectives: Medication errors are the most frequent cause of adverse events in the healthcare setting. Trauma patients are especially vulnerable to inadvertent medication reconciliation discrepancies, as they are frequently admitted under unexpected or emergent circumstances. Due to limitations in patient knowledge or of resources to obtain accurate information, it is not always possible to provide accurate medication name, dosage, or frequencies. The purpose of our study is to evaluate the USA Health University Hospital’s incidence and type of inadvertent medication reconciliation discrepancies among trauma patients.

Methods: This study is a prospective study of all patients admitted to the trauma service over a 30-day period. All patients admitted to the trauma service were prospectively assessed. Patients age < 18 years old, Glasgow Coma Scale (GCS) < 13, and those discharged within 24 hours were excluded. The remaining patients were interviewed for accuracy of their admission medication reconciliation (AMR), and their AMR was compared to independent data sources, including family, home pharmacy, and primary care records. Inadvertent medication reconciliation discrepancies were defined as an error of documentation of medication, including name, dose, or frequency. Additional factors collected were age of the patient, off-hours admission, time to completion from admission to completion of medication reconciliation form, the role of the person completing the form, and number of medications to be reconciled.

Results: We evaluated 159 patients. Seventy patients were excluded, leaving 89 for analysis. Twenty-six patients (29%) never received an AMR. Of the 63 patients that had a completed AMR, there were 107 inadvertent medication reconciliation errors identified from 30 separate patients (48%), for a rate of 3.6 errors per patient with any error. When evaluating other factors analyzed, there were no statistically significant differences in patients >65 years of age (77% vs. 68%, p=0.38), off-hours admission (72% vs 65%, p=0.52), role of person completing the form (nursing 65% vs. other 55%, p = 0.45), and 5 or more medications to reconcile (78% vs. 68%, p =0.35).

Conclusion: Our data shows that trauma patients have a high risk of inadvertent medication reconciliation discrepancies. Though this study was underpowered to determine a difference in independent risk factors, future studies should include a larger cohort analyzed to determine whether these are statistically significant.