Observational study of the prevalence of medication omissions at the time of hospital admission
Background. Obtaining medication history from hospitalized patients upon admission is a process fraught with potential errors. Faulty medication history may result in failure to identify potential or relevant drug-related problems or lead to inappropriate pharmacotherapy at the time of hospitalization. One of the most commonly observed errors in medication history is drug omission, where medication is not documented in the patient’s medical records. Clinical pharmacists globally practice medication review and reconciliation, reducing patient risks. This service is not established in Lithuania currently. To our knowledge there is no current data concerning medication omissions in Lithuania. Aim. The aim of the study was to evaluate the prevalence of medication omissions at the time of hospital admission and to identify the categories of medications associated with omissions. Methods. A prospective, observational study, included 187 patients, hospitalized in the cardiology department. A pharmacist conducted patient interviews and compared the information in patients’ medical records with the information obtained from the patients’ interviews. Results. The average number of medications used by the patients, as obtained through the interviews with the pharmacist was 7.95 (SD = 3.07). Medical records documented an average of 5.60 (SD = 2.64) medications. The mean number of medications omitted per patient was calculated at 2.34 (SD = 2.09). A higher incidence rate of medication omissions was observed in medication categories, less frequently used by the patients. 75% or more medications unrecorded in medical records fell within categories, including gastrointestinal medications, vasoprotectives, musculoskeletal system medications, dermatologicals, sensory organs medications, psychoanaleptics, other analgesics and antipyretics, antiepileptics, homoeopathic medications. Conclusion. This is the first research ever conducted in Lithuania regarding medication omissions from patients’ medical records, so it provides robust local data. The study confirmed the relevance of the problem in Lithuania: our results show a higher prevalence of medication omissions than those reported by other authors. According to scientific literature, nearly half of hospitalized patients have a least one of their medications omitted from their records. The current study revealed that 85.79% of patients had one or more medication omissions in their medical records. Nevertheless, the differences in results underscore the nature of the problem. Conducting similar research in other departments would further emphasize the issue and the necessity of developing a plan of measures to reduce patient risks. In conclusion, medication omissions are prevalent, with a higher incidence rate of omissions observed in drug classes unrelated to the main diagnosis within the analysed sample.