Table 4.
Medication-related problems identified by students during the medication reconciliation patient project
| Type of medication problem | Number of patients impacted | Medications |
|---|---|---|
| Therapeutic Duplication | 6 | 2 proton pump inhibitors (2), 2 statins, 2 beta blockers (3) |
| Therapeutic Omission at Discharge | 8 | Clopidogrel, Ramipril, Ranitidine, Vitamin B12 injection, Budesonide, Lisinopril, Tums, Prenatal vitamins, Carvedilol |
| Patient Did Not Take Medications Listed in Electronic Health Record (Non-Adherence) | 11 | Lisinopril, Bupropion, Aspirin, Multivitamin, Pantoprazole (2), Omeprazole, Metformin, Levothyroxine, Ergocalciferol, Pravastatin, Furosemide, Bactrim, Antipsychotic |
| Medications Used by Patients but Not Listed in Electronic Health Record | 14 | Fiber, Bisacodyl, Pantoprazole, Pravastatin, Magnesium, Vitamin B, Ciprofloxacin, Reservatol, CoQ-10, Ramipril, Ondansetron, Tylenol, Vitamin B-12, Tramadol, Aspirin, Glyburide, Ventolin, Multivitamin, Dexamethasone |
| Discharge List Included a Drug that Should Have Been Discontinued | 1 | Griseofulvin |
| Dosage too High | 4 | Warfarin, Aspirin, Oxycodone, Clonidine |
| Dosage too Low | 9 | Furosemide, Omeprazole, Doxycycline, Levothyroxine, Insulin, Hydrochlorothiazide, Gabapentin, Glimepiride, Lisinopril, Welchol |
| Drug-Disease Interaction | 2 | Omeprazole, Diclofenac |
| Drug-Drug Interaction | 16 | Amlodipine-simvastatin (2) |
| Oxybutynin-potassium | ||
| Escitalopram-pantoprazole | ||
| Methotrexate-pantoprazole | ||
| Sulfamethoxazole/trimethoprim-methotrexate | ||
| Potassium-spironolactone | ||
| Hydrochlorothiazide-vitamin D | ||
| Hydrochlorothiazide -NSAIDs | ||
| Aspirin-furosemide | ||
| Fluconazole-citalopram | ||
| Risperdone-ropinerole | ||
| Warfarin (unspecified) | ||
| Currently Having an Adverse Drug Event | 16 | Omeprazole, Warfarin (3), Simvastatin, Metoprolol, Lasix, Amlodipine, Lisinopril, Insulin, Glimepiride, Antiretroviral, Clonidine, Tramadol, Tobramycin, Pravastatin, Hydrochlorothiazide, Medroxyprogesterone, Metformin, Risperidone |
| Lack of Indication for Medication | 6 | Omprepazole, Promethazine, Reservatol, Vitamin E, CoQ10, Wellbutrin, Cinnamon, Colchicine, Viagra |
| Previously documented allergy, intolerance, or side effect | 1 | Tenofovir |
| Taking brand when generic is available | 1 | Simvastatin |