BACKGROUND: The accuracy of information transferred during hand-offs is uncertain. OBJECTIVE: To describe the frequency, types, and harm potential of medication discrepancies in resident-written sign-outs. DESIGN: Retrospective cohort study. PARTICIPANTS: Internal Medicine interns and their patients at a single hospital in January 2006. MEASUREMENTS: Daily written sign-outs were compared to daily medication lists in patient charts (gold standard). Medication discrepancies were labeled omissions (medication in chart, but not on sign-out) or commissions (medication on sign-out, but not in chart). Discrepancies were also classified as index errors (the first time an error was made) and the proportion of index errors that persisted on subsequent days. Using a modified classification scheme, discrepancies were rated as having minimal, moderate, or severe potential to harm. RESULTS: One hundred eighty-six of 247 (75%) patients and 10 of 10(100%) interns consented. In the 165 (89%) patients' charts abstracted and compared with the sign-out, there were 1,876 of 6,942 (27%) medication chart entries that were discrepant with the sign-out with 80% (1,490/1,876) labeled omissions. These discrepancies originated from 758 index errors, of which 63% (481) persisted past the first day. Omissions were more likely to persist than commissions (68% [382 of 580] vs 53% [99 of 188], p < .001). Greater than half (54%) of index discrepancies were moderate or severely harmful. Although omissions were more frequent, commissions were more likely to be severely harmful (38% [72 of 188] vs 11% [65 of 580], p < .0001). CONCLUSIONS: Written sign-outs contain potentially harmful medication discrepancies. Whereas linking sign-outs to electronic medical records can address this problem, current efforts should also emphasize the importance of vigilant updating in the many hospitals without this technology.
BACKGROUND: The accuracy of information transferred during hand-offs is uncertain. OBJECTIVE: To describe the frequency, types, and harm potential of medication discrepancies in resident-written sign-outs. DESIGN: Retrospective cohort study. PARTICIPANTS: Internal Medicine interns and their patients at a single hospital in January 2006. MEASUREMENTS: Daily written sign-outs were compared to daily medication lists in patient charts (gold standard). Medication discrepancies were labeled omissions (medication in chart, but not on sign-out) or commissions (medication on sign-out, but not in chart). Discrepancies were also classified as index errors (the first time an error was made) and the proportion of index errors that persisted on subsequent days. Using a modified classification scheme, discrepancies were rated as having minimal, moderate, or severe potential to harm. RESULTS: One hundred eighty-six of 247 (75%) patients and 10 of 10(100%) interns consented. In the 165 (89%) patients' charts abstracted and compared with the sign-out, there were 1,876 of 6,942 (27%) medication chart entries that were discrepant with the sign-out with 80% (1,490/1,876) labeled omissions. These discrepancies originated from 758 index errors, of which 63% (481) persisted past the first day. Omissions were more likely to persist than commissions (68% [382 of 580] vs 53% [99 of 188], p < .001). Greater than half (54%) of index discrepancies were moderate or severely harmful. Although omissions were more frequent, commissions were more likely to be severely harmful (38% [72 of 188] vs 11% [65 of 580], p < .0001). CONCLUSIONS: Written sign-outs contain potentially harmful medication discrepancies. Whereas linking sign-outs to electronic medical records can address this problem, current efforts should also emphasize the importance of vigilant updating in the many hospitals without this technology.
Authors: Patricia L Cornish; Sandra R Knowles; Romina Marchesano; Vincent Tam; Steven Shadowitz; David N Juurlink; Edward E Etchells Journal: Arch Intern Med Date: 2005-02-28
Authors: David Meltzer; Willard G Manning; Jeanette Morrison; Manish N Shah; Lei Jin; Todd Guth; Wendy Levinson Journal: Ann Intern Med Date: 2002-12-03 Impact factor: 25.391
Authors: Ross Koppel; Joshua P Metlay; Abigail Cohen; Brian Abaluck; A Russell Localio; Stephen E Kimmel; Brian L Strom Journal: JAMA Date: 2005-03-09 Impact factor: 56.272
Authors: Heather C O'Donnell; Rainu Kaushal; Yolanda Barrón; Mark A Callahan; Ronald D Adelman; Eugenia L Siegler Journal: J Gen Intern Med Date: 2008-11-08 Impact factor: 5.128
Authors: Vineet M Arora; McKenna C Eastment; Emily D Bethea; Jeanne M Farnan; Erica S Friedman Journal: J Gen Intern Med Date: 2013-08 Impact factor: 5.128
Authors: Joshua Davis; Lee Ann Riesenberg; Matthew Mardis; John Donnelly; Branden Benningfield; Mallory Youngstrom; Imelda Vetter Journal: J Grad Med Educ Date: 2015-06