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Journal Article > Study
Incidence of clinically relevant medication errors in the era of electronically prepopulated medication reconciliation forms: a retrospective chart review.
Stockton KR, Wickham ME, Lai S, et al. CMAJ Open. 2017;5:E345-E353.
An accurate list of patient medications is a necessary precursor for safe medication use. One strategy to improve medication reconciliation is to provide a list of dispensed outpatient medications to inpatient clinicians upon hospital admission via an electronic medication reconciliation process. This retrospective chart review study compared a research pharmacist–generated gold standard medication list to the actual medications ordered during an admission after such a process was implemented. The study team identified medication discrepancies between the pharmacist-generated and admission-ordered medication lists and noted any inappropriately prescribed or continued medications. Medication errors were present in nearly half of the patient records; about 9% of errors were clinically important. The authors raise concerns that electronically prepopulated medication reconciliation forms may actually adversely impact medication safety. A previous WebM&M commentary discussed how to enhance accuracy of medication reconciliation.
Journal Article > Study
Eguale T, Buckeridge DL, Verma A, et al. JAMA Intern Med. 2016;176:55-63.
Prescribing medications for indications that are not approved by the Food and Drug Administration—so-called off-label prescribing—is common. Although it is invariably well-intentioned, this population-based study demonstrates that off-label prescribing is a risk factor for medication errors. The study used the electronic medical record in Quebec that required physicians to enter the reason for prescribing or discontinuing medications to analyze the frequency of off-label prescribing and adverse events associated with this practice. Off-label prescribing was associated with a higher adverse drug event risk, especially when there was no convincing scientific indication for the unapproved use (which was the case in more than 80% of off-label prescriptions). The accompanying editorial notes that the FDA is under pressure to relax restrictions on marketing of drugs for off-label purposes and raises the concern that eliminating such restrictions could expose more patients to adverse events.