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Lookout for these common medication discrepancies
Missing these could impact safety
Hospitals sometimes miss potential medication safety problems because the medication reconciliation did not note discrepancies in the patient's diagnosis and prescribed medications.
A researcher who has studied medication discrepancies among hospitalized patients highlights some of the more common discrepancies that may occur:
• Proton pump inhibitors (PPI): Hospital patients often will report taking a PPI, but they fail to mention they have an ulcer or gastroesophageal reflux disease (GERD), says Douglas Slain, PharmD, BCPS, FCCP, an associate professor in the department of clinical pharmacy at West Virginia University School of Pharmacy in Morgantown, WV.
"Maybe their condition isn't serious enough to call a condition," Slain suggests. "But when we ask people through direct questioning, 'Why are you taking this pill?' they'll say they have reflux."
So a hospital pharmacist should ask this question of the health care team: "Does the patient need to stay on the treatment indefinitely?" Slain says.
"I think patients always should be evaluated to see if they can discontinue certain medications," he says.
There are several reasons why patients taking PPIs might no longer need the treatment.
For instance, when patients are admitted to the hospital for an acute illness or for surgery, some are placed on PPIs to prevent stress-related mucosal disease, Slain says.
"Then when they are discharged the physician will write a discharge prescription," Slain explains. "It's been shown the patients will continue as outpatients on these drugs although they were prescribed the medication for the purpose of stress ulcer prophylaxis and there was no long-term intent for their using these drugs."
In Slain's recent research on medication discrepancies, there were numerous instances of patients taking PPIs when there were not medical indications initially reported for the treatment.1
"There were cases where we could not clarify why they were on that drug," Slain says.
• Selective serotonin reuptake inhibitors (SSRIs): In the study on medication discrepancies, there were so many patients who omitted why they were taking SSRIs that investigators wondered if it was a deliberate omission because of a perceived stigma if they were to admit to having depression, Slain notes.
The other possibility is that patients are prescribed SSRIs by primary care physicians instead of by psychiatrists, and they might not always be told that they're being treated for depression or anxiety, Slain says.
"Are they being told this drug might help your nerves or your mood?" he says. "There might be something about this interaction that makes it difficult for the patient to tell us at a later point why they're taking the medication."
So pharmacists conducting medication reconciliations might need to ask specifically about SSRIs, or they might need to inquire about depression or anxiety when they see that a patient is taking an SSRI.
• Benzodiazepines: This class of psychoactive drugs can be used for treating anxiety, sleep disorders, seizures, or neuropathy.
Patients who are being treated for a neuropathy might not say why they're taking the drug, so pharmacists would need to clarify the diagnosis through direct questioning, Slain says.
For example, pharmacists conducting the medication reconciliation might note that a patient taking a benzodiazepine is a diabetic, which could suggest the patient has a neuropathy, Slain says.
• Sedative-hypnotics: Slain suggests that pharmacists watch for cases where elderly patients are taking sleeping pills and other sedative-hypnotics because some of these drugs are on the Beers Criterias for potentially inappropriate medication use in older adults.2