Prevalence and risk factors for medication discrepancies on admission of elderly diabetics at Kenyatta National Hospital, Kenya.

Abstract

Background Medication discrepancies are defined as the variations in drug regimens during transition from one health care worker or hospital to another. These medication discrepancies are either intentional or unintentional and can lead to errors which can be detrimental to patients and in the long term result in Medication Related Problems (MRPs). The unintentional discrepancies can result in poor management of acute and chronic diseases, hospital readmission, and death. Elderly diabetic patients are at high risk of medication discrepancies due to their multiple chronic diseases resulting in different medication from the many healthcare providers they are likely to see. The fact that they are elderly and undergoing normal age related changes also puts them at high risk. Medication Reconciliation is therefore needed to identify and rectify these discrepancies to promote patient safety. Objectives The main objective of the study was to measure the prevalence and identify risk factors for medication discrepancies at admission in inpatient elderly diabetics at Kenyatta National Hospital (KNH). Methodology A cross sectional study was carried out involving elderly diabetic patients aged 60 years and above admitted to the medical wards at Kenyatta National Hospital (KNH) in 2016. Convenient sampling was done to select the participants who met the inclusion criteria. The participants who gave consent were recruited 24 hours after admission. Data was abstracted from patient medical files, patient/caregiver interviews, clinical discharge summaries and a physical check of drugs in use. A comparison of the medication used before and after admission was done to determine the number of discrepancies. The discrepancy types identified were classified into intentional, undocumented intentional and unintentional discrepancies. Linear regression was done to identify risk factors for medication discrepancies. v Results Among the 163 patients recruited, 1089 medication discrepancies were identified. On classification, 849 (78%) were intentional and 240 (22%) were unintentional. Among the unintentional, 225 (94%) had the potential for harm with a prevalence rate of 1.4 per patient. The most common discrepancy type is omissions 236 (98.3%). Only 94 (42%) of the 225 unintended discrepancies were resolved. Exactly, 63.2% of the patients had at least one unintentional discrepancy (medication error). Independent risk factors for number of discrepancies were the number of medications prior to admission (adjusted β coefficient 1.377 (95% CI: 0.767, 1.987)), hypertension (β 0.992 (95% CI: 0.094, 1.890)) and those with discharge forms from previous facilities (β 0.701 (95% CI: 0.010, 1.392)). Age had a negative association with medication discrepancies (β -0.755 (95% CI: -1.284, -0.226)). Conclusion Medication discrepancies are common on admission. Our results support the importance of a comprehensive medication history at hospital admission and putting in place a medication reconciliation program, as demonstrated throughout the literature.