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MEDICATION SAFETY

Drug-Related Problems on Hospital Admission: Relationship to Medication Information Transfer

Pharmacist, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada

Olavo A Fernandes, PharmD

Clinical Site Leader, Toronto General Hospital, University Health Network; Assistant Professor, Leslie Dan Faculty of Pharmacy, University of Toronto

Annemarie Cesta, BScPhm

Pharmacist, Toronto General Hospital, University Health Network

Jana M Bajcar, MScPhm EdD FCSHP

Associate Professor, Leslie Dan Faculty of Pharmacy, University of Toronto

Reprints: Dr. Olavo Fernandes, Inpatient Pharmacy Department, Toronto General Hospital, Gerrard Wing, Ground Floor, Rm. 579, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada, fax 416/340-3685, olavo.fernandes{at}uhn.on.ca

BACKGROUND: Patients with end-stage renal disease (ESRD) are at risk for drug-related problems (DRPs), especially on hospital admission.

OBJECTIVE: To identify and characterize the DRPs experienced by patients with ESRD on admission and investigate how these DRPs could be related to gaps in medication information transfer.

METHODS: Patients with ESRD admitted to the hospital were prospectively identified and clinically assessed by a pharmacist to identify and categorize DRPs on admission. Each DRP was evaluated to determine whether it could have been caused by a gap in medication information transfer. For DRPs caused in this manner, the interface in the information transfer process where the gap may have occurred was determined.

RESULTS: A total of 199 DRPs were identified in 47 patients with ESRD over a 12 week period. Ninety-two percent of patients had at least one DRP on admission, with an average of 4.2 ± 2.2 DRPs per patient. The most common DRP identified was indication for drug therapy—patient requires drug but is not receiving it (51.3%). Of the total DRPs, 130 (65%) were related to gaps in medication information transfer, with 21.5% occurring between the inpatient hospital and the ambulatory clinic pharmacists and 17.7% between the admitting physician and the patient.

CONCLUSIONS: Results of this study demonstrate that, in patients with ESRD, DRPs on admission are frequently related to gaps in medication information transfer between healthcare professionals and also between healthcare providers and patients. Improved communication is required at medication information transfer interfaces to prevent these DRPs.

Key Words: drug-related problems, end-stage renal disease

Published Online, February 21, 2006. www.theannals.com, DOI 10.1345/aph.1G482

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