Category: Professional Posters
Purpose: Medication reconciliation is a vital step in ensuring patient safety across the continuum of care is completed in a timely fashion. Our objectives are to evaluate the incidence and characteristics of discharge medication discrepancies that are identified by pharmacists during discharge medication reconciliation for cardiac center patients at King Fahad Medical City(KFMC) in Saudi Arabia, in addition, will attempt to identify risk factors that may affect medication discrepancy occurrence during medication reconciliation.
Methods: A prospective observational study conducted at a tertiary care hospital in Riyadh for a period of 4 months. We collected data from discharge prescriptions which came to the pharmacy and compared it with medication administration record (MAR), medication history in the cortex system© and patient home medication list obtained from medication reconciliation form from ER during admission. We included all adult patients discharged from the cardiac center at KFMC.
Results: A total of 776 patients were enrolled in the study. 64.7% were male 35.3 were female. 180 patients (23.1%) out of 776 patients experienced 237 discrepancies. 73.4% of the discrepancies were intentional and 26.6% were un-intentionally discrepancies. Medication discrepancies were not associated with an increased number of prescribed medication (P-value = 0.081) and with increased age (P- value = 0.366). However, the Severity of medication discrepancy was having an association with medication discrepancy (P-value < 0.001). Minor discrepancies were increased with intentional medication discrepancy, whereas major discrepancies were increased with Un-intentional medication discrepancy (P-value < 0.001).
Conclusion: At our hospital, one in four discharged cardiac patients had medication discrepancies. There were no association of age, increased number of medications with the number of medication discrepancy; However, un-intended medication discrepancy can be associated with increased adverse events leading to increase the number of ER/ hospital admission and associated costs. More studies with larger sample size are warranted to confirm this result.