Electronic health records and adverse drug events after patient transfer

• Published in: Quality & safety in health care Vol. 19; no. 5; p. e16
• Main Authors: Boockvar, K S, Livote, E E, Goldstein, N, Nebeker, J R, Siu, A, Fried, T
• Format: Journal Article
• Language: English
• Published: England 01-10-2010
• Subjects: Aged; Aged, 80 and over; Cohort Studies; Connecticut - epidemiology; Drug-Related Side Effects and Adverse Reactions - epidemiology; Electronic Health Records; Female; Hospitals; Humans; Male; Medical Audit; Middle Aged; New York - epidemiology; Nursing Homes; Patient Transfer; New York; Connecticut
• ISSN: 1475-3901
• DOI: 10.1136/qshc.2009.033050

Our objective was to examine the frequencies of medication error and adverse drug events (ADEs) at the time of patient transfer in a system with an electronic health record (EHR) as compared with a system without an EHR. It was hypothesised that the frequencies of these events would be lower in the EHR system because of better information exchange across sites of care.
469 patients transferred between seven nursing homes and three hospitals in New York and Connecticut between 1999 and 2005 were followed retrospectively. Two groups of patients were compared: US Veterans Affairs (VA) patients, with an EHR, and non-VA patients, without an EHR, on the following measures: (1) medication prescribing discrepancies at nursing home/hospital transfer, (2) high-risk medication discrepancies and (3) ADEs caused by medication discrepancies according to structured medical record review by pairs of physician and pharmacist raters.
The overall incidence of ADE caused by medication discrepancies was 0.20 per hospitalisation episode. After controlling for demographic and clinical covariates, there were no significant differences between VA and non-VA groups in medication discrepancies (mean difference 0.02; 95% CI -0.81 to 0.85), high-risk medication discrepancies (-0.18; 95%CI -0.22 to 0.58) or occurrence of an ADE caused by a medication discrepancy (OR 0.96; 95% CI 0.18 to 5.01).
There was no difference, with and without an EHR, in the occurrence of medication discrepancies or ADEs caused by medication discrepancies at the time of transfer between sites of care. Reducing such problems may require specialised computer tools to facilitate medication review.