Assessing accuracy of an electronic provincial medication repository

Morgan Price,Francis Lau,Stan Bardal,Nicole Kitson,Mike Bowen

doi:10.1186/1472-6947-12-42

Abstract

BackgroundJurisdictional drug information systems are being implemented in many regions around the world. British Columbia, Canada has had a provincial medication dispensing record, PharmaNet, system since 1995. Little is known about how accurately PharmaNet reflects actual medication usage.MethodsThis prospective, multi-centre study compared pharmacist collected Best Possible Medication Histories (BPMH) to PharmaNet profiles to assess accuracy of the PharmaNet profiles for patients receiving a BPMH as part of clinical care. A review panel examined the anonymized BPMHs and discrepancies to estimate clinical significance of discrepancies.Results16% of medication profiles were accurate, with 48% of the discrepant profiles considered potentially clinically significant by the clinical review panel. Cardiac medications tended to be more accurate (e.g. ramipril was accurate >90% of the time), while insulin, warfarin, salbutamol and pain relief medications were often inaccurate (80–85% of the time). 1215 sequential BPMHs were collected and reviewed for this study.ConclusionsThe PharmaNet medication repository has a low accuracy and should be used in conjunction with other sources for medication histories for clinical or research purposes. This finding is consistent with other, smaller medication repository accuracy studies in other jurisdictions. Our study highlights specific medications that tend to be lower in accuracy.

Highlights

Jurisdictional drug information systems are being implemented in many regions around the world
Pharmacists documented the patient’s Best Possible Medication Histories (BPMH) in a Microsoft Access database as part of routine care and were asked to document any discrepancies discovered between their BPMH and the patient’s PharmaNet profile.a Discrepancy types were predefined: medication missing on PharmaNet profile, medication erroneously flagged as “current” on profile but not being taken, medication missing the “current” flag on PharmaNet Profile (NOTE: the current flag was an additional feature provided in the vendor software used to display PharmaNet profiles), error in dose, error in route, error in frequency, and unclear ingredient or instruction
This study revealed a high number of discrepancies (84.3%) between the gold standard Best Possible Medication History and medication profiles found in the PharmaNet provincial medication database

Summary

Introduction

Jurisdictional drug information systems are being implemented in many regions around the world. British Columbia, Canada has had a provincial medication dispensing record, PharmaNet, system since 1995. In a review by Bates, prescription medication errors occurred in up to 67% of patients being admitted to hospital with 11–59% of those being clinically important [5,6]. PharmaNet is British Columbia’s (BC) provincial repository of medication dispensings from community pharmacies. Authorized clinicians in community pharmacies, hospitals, emergency departments and medical practices can access PharmaNet to view medication dispensing records. A survey of BC physicians reported that there was a perceived impact on prescribing practice in 20% of treatment decisions [16].A study of 55 admission medication histories showed reviewing PharmaNet helped identify drug therapy problems but did not appear to improve medication histories [17]

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Discussion

Conclusion