REAMINAS—A Retrospective Study Evaluating the Completeness of the Emergency Department’s Admission Medication and Its Influence on Discharge Medication

Background: Documentation of admission medication is frequently insufficient, particularly in the emergency department (ED). This study analyses discrepancies between the admission medication by ED physicians and pharmaceutical medication reconciliation (PMR) at the emergency admission ward, their clinical relevance, and influence on discharge medication. Methods: In a retrospective observational study (May 2022–April 2023) on an interdisciplinary emergency admission ward, unintended medication discrepancies (UMDs) between ED admission medication and PMR, as well as prescription discrepancies (PDs) between admission medication prescribed at the emergency admission ward and PMR, were analysed. Persistence of PDs up to discharge was evaluated. Drugs associated with discrepancies were classified for clinical relevance during hospitalisation as (A) relevant for documentation and prescription, (B) relevant for documentation but irrelevant for prescription, or (C) irrelevant for documentation and prescription. Additionally, a list of high-risk drugs was established. Results: For 256 patients, a median of three (Q1–Q3 0–6.75) and five (2–8) drugs were documented as admission medication in the ED and PMR, respectively, with a median of two (1–5) UMDs per patient. For Group A drugs, the admission medication prescribed at the emergency admission ward compared to the PMR resulted in a median of one (0–3) PD per patient. Drug omission was most common (60.0 and 61.0% of UMDs and PDs, respectively). A total of 22.8% of UMDs and 23.8% of PDs concerned high-risk drugs. Of 215 PDs eligible for discharge analysis, 137 (63.7%) persisted up to the discharge letter. Conclusions: A considerable number of discrepancies were found between the admission medication in the ED and PMR. A substantial proportion of these were caused by high-risk drugs, highlighting their potential to harm patients. Discrepancies tend to persist throughout hospitalisation up to the discharge letter.