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GP records 'don't match' aged care medication charts for 95% of residents

Researcher Professor Meredith Makeham blames poor information sharing between aged care and GP practices

11th September 2020

By Siobhan Calafiore

The details of medications listed in GP practice records don't match those in patients' nursing home medication lists in 95% of cases, an Australian study suggests.

Researchers say while not all discrepancies could be considered harmful, some were significant enough to potentially cause serious polypharmacy adverse events.

Led by Sydney GP Professor Meredith Makeham, they analysed medication lists for 203 residents at 53 nursing homes in northern Sydney.

The medication lists held in nursing homes indicated the residents had been collectively prescribed some 2447 medicines.

However, when it came to the practice records held by their GPs, there were 2363 scripts recorded, many with details that were different in some way to those scripts documented on the nursing home medication list.

Overall 1700 discrepancies were found: some 35% related to drugs omitted from GP records, 34% related to different doses recorded and 30% were additional drugs on the GP medication lists.

This equated to a rate of 73 discrepancies for every 100 medications, the researchers wrote in the International Journal of Medical Informatics.

Professor Makeham, associate dean at the community and primary health care faculty at the University of Sydney, said the results were concerning. 

“That was quite startling, and we were certainly very diligent about ensuring we were matching the correct records for the right person between those two settings,” she said. 

She said the data suggested almost one in 10 of the discrepancies identified by her team had the potential to lead to severe discomfort or clinical deterioration for the patient.

“In a situation where the resident might need another medicine prescribed urgently by their GP over the phone - perhaps they have an acute infection - you could have a situation where the GP may choose to commence an antibiotic medication but they won’t have the correct medication list in front of them in which to refer.

“So they won’t be able to properly check for medication interactions and avoid potential side effects unless the aged care facility faxes them the medication chart."

More here:

https://www.ausdoc.com.au/news/gp-records-dont-match-aged-care-medication-charts-95-residents

Here is the abstract.

The General Practice and Residential Aged Care Facility Concordance of Medication (GRACEMED) study

Meredith Makeham^ab Lisa Pont^cd Carlijn Verdult^ce Rae-Anne Hardie^d Magdalena Z. Raban^d Rebecca Mitchell^f Helen Purdy^g Martina Teichert^e Andrew Ingersoll^h Johanna I.Westbrook^d

https://doi.org/10.1016/j.ijmedinf.2020.104264Get rights and content

Abstract

Background

The lack of interoperable IT systems between residential aged care facilities (RACF) and general practitioners (GP) in primary care settings in Australia introduces the potential for medication discrepancies and other medication errors. The aim of the GRACEMED study is to determine the extent and potential severity of medication discrepancies between general practice and RACFs, and identify factors associated with medication discrepancies.

Methods

A cross sectional study of medication discrepancies between RACF medication orders and GP medication lists was conducted in the Sydney North Health Network, Australia. A random sample of RACF residents was included from practice lists provided by the general practices. RACF medication orders and GP medication lists for the included residents were compared, and medication discrepancies between the two sources were identified and characterised in terms of discrepancy type, potential for harm and associated factors.

Results

31 GPs and 203 residents were included in the study. A total of 1777 discrepancies were identified giving an overall discrepancy rate of 72.6 discrepancies for every 100 medications. Omissions were the most common discrepancy type (35.2%,) followed by dose discrepancies (34.4%) and additions (30.4%). 48.5% of residents had a discrepancy with the potential to result in moderate harm and 9.8% had a discrepancy with the potential for severe harm. Number of medications prescribed was the only factor associated with medication discrepancies.

Conclusion

Increased use of systems that allow information sharing and improved interoperability of clinical information is urgently needed to address medication safety issues experienced by RACF residents.

Here is the link:

https://www.sciencedirect.com/science/article/abs/pii/S138650562030071X#!

I have to say Prof. Makeham’s use of the word ‘startling’ about the results is absolutely justified and really worrying. The potential for severe harm is clearly large and this paper should provoke some serious thinking on the part of stakeholders to address the problems in a systemic way – as the problem is clearly systemic and severe.

For what it is worth I believe that local pharmacies are the key as they are the ones who probably have the best records as to what they have supplied and are supplying to RACFs.

Having the pharmacists reconcile what they are providing to patients with what the GPs think the patient is receiving might be a good start. It would seem some form of PIP payment / financial incentives will probably be needed to grease the flow of information.

One approach might be to have the RACFs have a clinical record that was accessible (with relevant security and controls) by both Pharmacists and GPs so the right and left hand would know what is going on.

If the GP could be confident that all the patient’s pharmacy information has actually been uploaded to the My Health Record (and the patient / resident has a record), this white elephant might actually find a real use as the records could be downloaded when clinical visits were planned or as a routine to ensure therapy was as desired. Again to have enough uploads happen I suspect some incentives would be needed.

Another way might be to have local pharmacists do a regular review in RACFs and then reconcile the therapy with the relevant GP if needed.

What do others think would be the cheapest and best way to solve the problem, as right now it looks pretty bad?

David.