Pharmacy World & Science

, Volume 32, Issue 4, pp 449–454 | Cite as

Discrepancies between sources providing the medication histories of acutely hospitalised patients

  • Louise Lindved KarkovEmail author
  • Simon Schytte-Hansen
  • Lotte S. Haugbølle
Research Article


Objective The aim of this study was to clarify the number and type of discrepancies between four medication sources as well as their potential clinical significance to the patient. Method The study was conducted as a cross-sectional study comprising all patients hospitalised with hip fractures in the Orthopaedic Surgery Ward at Amager Hospital. Data were collected from four sources. All information was counted, and the potential clinical significance of discrepancies was evaluated on a five-point scale. The four sources are: patients, the Personal Electronic Medication Profile (PEM), the general practitioner (GP) and the in-home care provider. A discrepancy was defined as any disagreement or omission of information between the four sources concerning name, form, strength and dose for each drug with which the patient was being treated. Main outcome measure The number of discrepancies between the data sources. Results A total of 69 medications were registered for nine patients or an average of 7.7 medications per patient. 10.1 discrepancies per patient and 1.3 discrepancies per drug were registered. Two discrepancies were assessed as having potentially lethal clinical significance. Forty-one discrepancies were assessed as clinically significant, while 36 discrepancies were assessed as possessing minor clinical significance. The PEM added nine prescription drugs that no other sources mentioned. The addition of these medicines was largely clinically significant. Conclusion A total of 91 discrepancies were registered for nine patients. Two of these discrepancies were fatal and 41 were clinically significant.


Medication discrepancies Medication history Personal Electronic Medication Profile Sector transition 



The authors thank Jan Andersen, Chief Physician, at the Orthopaedic Surgery Ward at Amager Hospital, Anders Peter Balslev-Clausen, Resident, at the Orthopaedic Surgery Ward at Amager Hospital and Louise G. Gammelgaard, Clinical Pharmacist, at Amager Hospital for their help in the evaluation of the detected discrepancies. We would also like to thank participating staff for their help in finding eligible patients.


There has been no funding for this study.

Conflicts of interest

None declared.


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Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Louise Lindved Karkov
    • 1
    Email author
  • Simon Schytte-Hansen
    • 1
  • Lotte S. Haugbølle
    • 1
  1. 1.Copenhagen UniversityCopenhagenDenmark

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