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Does Electronic Medication Reconciliation at Hospital Discharge Curb Distracted Prescribing for Outpatient Parenteral Antibiotic Therapy? A Pilot Study

Session: Poster Abstract Session: Clinical Practice Issues
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Medication errors at hospital discharge are an important safety issue that can affect Outpatient Parenteral Antibiotic Therapy (OPAT) outcomes. Electronic medication reconciliation is a process to correct discrepancies at healthcare transitions. This study takes a novel approach of measuring types and prevalence of intravenous (IV) antibiotic errors at hospital discharge before and after the implementation of a mandatory electronic discharge medication reconciliation tool (EDMRT).  This study was approved by Tufts Medical Center IRB.

Methods: A retrospective study at tertiary hospital where residents order discharge medications. One hundred pre-EDMRT and 100 post-EDMRT subjects were recruited at random from Tufts Medical Center’s clinical OPAT program. Using infectious disease (ID) recommendations as gold standard, we compared each antibiotic listed in ID consultants’ notes to the hospital discharge orders and defined any discrepancy as an error i.e., the outcome of interest. After generating crude odds ratio of discharge with antibiotic error in the post-EDMRT era compared to the pre-EDMRT era, multivariable regression was performed to account for potential confounding: day of discharge (weekend vs. weekday), average years of practice by prescriber, type of inpatient service (medicine vs. surgery) and total number of medications per subject.

Results: Prevalence of intravenous antibiotic errors decreased from 30 errors among 100 pre-EDMRT subjects to 15 errors among 100 post-EDMRT subjects. Dosages were the most common error type. Adjusted odds ratios (OR) of discharge with intravenous antibiotic error in the post-EDMRT era 0.39 (95% CI: 0.18, 0.87, p=0.021) respectively compared to the pre-EDMRT era. Adjusted OR was nearly identical to crude OR (0.41).  Number of discharge medications was associated with increased OR of discharge error, suggesting an underlying mechanism of “distracted prescribing”. 

Conclusion: Prevalence of antibiotic errors was significantly lower in the post-EDMRT era. Electronic medication reconciliation may be important to curb distracted prescribing.  Our outcomes demonstrate the value of an OPAT program, which caught and addressed these errors in real-time as patients were discharged.

Bernard Weigel, Economics, Tufts University, Somerville, MA, Geneve Allison, MD, MSc, FACP, Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA and Christina Holcroft, ScD, Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA


B. Weigel, None

G. Allison, None

C. Holcroft, None

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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