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

Authors

    • Division of Quality and Operations, Department of Clinical Quality ManagementNorthwestern Memorial Hospital
    • Northwestern Memorial Hospital
  • Molly R. McDaniel
    • Division of Quality and Operations, Department of Clinical Quality ManagementNorthwestern Memorial Hospital
    • Pharmacy and Clinical PerformanceSanford Health
  • Joseph Feinglass
    • Division of General Internal Medicine, Department of MedicineNorthwestern University Feinberg School of Medicine
    • Institute for Healthcare StudiesNorthwestern University Feinberg School of Medicine
  • David W. Baker
    • Division of General Internal Medicine, Department of MedicineNorthwestern University Feinberg School of Medicine
    • Institute for Healthcare StudiesNorthwestern University Feinberg School of Medicine
  • Lee Lindquist
    • Division of General Internal Medicine, Department of MedicineNorthwestern University Feinberg School of Medicine
    • Institute for Healthcare StudiesNorthwestern University Feinberg School of Medicine
  • David Liss
    • Division of General Internal Medicine, Department of MedicineNorthwestern University Feinberg School of Medicine
    • Department of Health ServicesUniversity of Washington School of Public Health
  • Gary A. Noskin
    • Institute for Healthcare StudiesNorthwestern University Feinberg School of Medicine
    • Division of Infectious Diseases, Department of MedicineNorthwestern University Feinberg School of Medicine
Original Article

DOI: 10.1007/s11606-010-1256-6

Cite this article as:
Gleason, K.M., McDaniel, M.R., Feinglass, J. et al. J GEN INTERN MED (2010) 25: 441. doi:10.1007/s11606-010-1256-6

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 reconciliationmedication errorsmedication history taking

Copyright information

© Society of General Internal Medicine 2010