Original Article

Journal of General Internal Medicine

, Volume 25, Issue 5, pp 441-447

Results of the Medications At Transitions and Clinical Handoffs (MATCH) Study: An Analysis of Medication Reconciliation Errors and Risk Factors at Hospital Admission

  • Kristine M. GleasonAffiliated withDivision of Quality and Operations, Department of Clinical Quality Management, Northwestern Memorial HospitalNorthwestern Memorial Hospital Email author 
  • , Molly R. McDanielAffiliated withDivision of Quality and Operations, Department of Clinical Quality Management, Northwestern Memorial HospitalPharmacy and Clinical Performance, Sanford Health
  • , Joseph FeinglassAffiliated withDivision of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of MedicineInstitute for Healthcare Studies, Northwestern University Feinberg School of Medicine
  • , David W. BakerAffiliated withDivision of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of MedicineInstitute for Healthcare Studies, Northwestern University Feinberg School of Medicine
  • , Lee LindquistAffiliated withDivision of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of MedicineInstitute for Healthcare Studies, Northwestern University Feinberg School of Medicine
  • , David LissAffiliated withDivision of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of MedicineDepartment of Health Services, University of Washington School of Public Health
  • , Gary A. NoskinAffiliated withInstitute for Healthcare Studies, Northwestern University Feinberg School of MedicineDivision of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine

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Abstract

Background

This study was designed to determine risk factors and potential harm associated with medication errors at hospital admission.

Methods

Study pharmacist and hospital-physician medication histories were compared with medication orders to identify unexplained history and order discrepancies in 651 adult medicine service inpatients with 5,701 prescription medications. Discrepancies resulting in order changes were considered errors. Logistic regression was used to analyze the association of patient demographic and clinical characteristics including patients’ number of pre-admission prescription medications, pharmacies, prescribing physicians and medication changes; and presentation of medication bottles or lists. These factors were tested after controlling for patient demographics, admitting service and severity of illness.

Results

Over one-third of study patients (35.9%) experienced 309 order errors; 85% of patients had errors originate in medication histories, and almost half were omissions. Cardiovascular agents were commonly in error (29.1%). If undetected, 52.4% of order errors were rated as potentially requiring increased monitoring or intervention to preclude harm; 11.7% were rated as potentially harmful. In logistic regression analysis, patient’s age ≥65 [odds ratio (OR), 2.17; 95% confidence interval (CI), 1.09–4.30] and number of prescription medications (OR, 1.21; 95% CI, 1.14–1.29) were significantly associated with errors potentially requiring monitoring or causing harm. Presenting a medication list (OR, 0.35; 95% CI, 0.19–0.63) or bottles (OR, 0.55; 95% CI, 0.27–1.10) at admission was beneficial.

Conclusion

Over one-third of the patients in our study had a medication error at admission, and of these patients, 85% had errors originate in their medication histories. Attempts to improve the accuracy of medication histories should focus on older patients with a large number of medications. Primary care physicians and other clinicians should help patients utilize and maintain complete, accurate and understandable medication lists.

KEY WORDS

medication reconciliation medication errors medication history taking