Identifying Patients at High Risk for Medication History Errors at the Time of Hospital Admission

1University of California San Diego, San Diego, CA
2University of California San Diego, San Diego, CA
3University of California San Diego, San Diego, CA

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 116


The eighth National Patient Safety Goal, developed by the Joint Commission in 2009, emphasizes the importance of reconciliation of medications during the entire period of hospitalization. The medication reconciliation process starts with obtaining the medication history of a patient at the time of hospital admission. Inaccuracies in the home medication list may persist across transitions in care and may lead to medication errors and possible adverse drug events (ADEs). Studies have shown that pharmacist involvement in obtaining a medication history decreases the number of medication errors. However, because of funding limitations, hospitals may have difficulty utilizing pharmacists for this role. Another option would be to limit the use of pharmacists to patients at high‐risk for medication history errors. It would be useful to identify which groups of patients are high risk.


Consenting patients aged 18 years or older who were admitted to the general medicine service at an urban academic medical center were interviewed by a trained pharmacy student. Medication history was obtained from the patient, using a translator if needed, and verified by their pharmacy. This list was then compared to the standard physician‐obtained medication list in the patient's chart. Medication discrepancies were then identified between the 2 lists and noted as errors. Data were dichotomized for age (< 65 or > 65 years old), language (English speaking vs. non–English speaking), and polypharmacy (> 5 medications or < 5 medications used). Logistic regression was used to calculate adjusted odds ratios for medication errors in each group.


One hundred and fifty‐four patients were interviewed. There were 42 patients who were < 65 years old, English‐speaking, and took < 5 medications; 26 patients who were > 65 years old (elderly); 19 who were non‐English speaking; and 102 with poly pharmacy. The overall average number of medication errors identified per patient was 3.8. The most common type of error was omitted or incorrect medication. Regression analysis revealed the following adjusted odds ratios for each group: elderly 1.03 (95% CI 0.91–1.17), non‐English speaking 0.87 (95% Cl 0.72–1.06), and polypharmacy 1.85 (95% Cl 1.46–2.35).


Pharmacy student involvement in obtaining medication admission history identified multiple medication errors per patient on physician‐obtained histories. Although patients with polypharmacy had a significantly increased risk of medication errors, non‐English‐speaking and elderly patients did not appear to be at higher risk of errors. If pharmacy resources are limited, utilizing pharmacists or pharmacy students in the high‐risk polypharmacy group may have the most impact on decreasing medication errors. Further study is necessary to clarify if pharmacist involvement leads to an associated decreased risk of ADEs.

Author Disclosure:

J. Quartarolo, none; K. Hollenbach none; C. Lu, Kaiser Permanente, employment.

To cite this abstract:

Quartarolo J, Lu C, Hollenbach K. Identifying Patients at High Risk for Medication History Errors at the Time of Hospital Admission. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 116. Journal of Hospital Medicine. 2010; 5 (suppl 1). Accessed May 23, 2019.

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