Table 3.

Examples of unintentional medication discrepancies with the potential to cause severe discomfort or clinical deterioration in patients (Class 3)

	Medication discrepancy
Reason for hospital admission	type	description
Polypus colonis	Drug omission	Patient reported use of warfarin 1.5 mg/d before admission, which was not ordered on admission.
Pancreatic duct stones	Drug addition	Patient was taking tramadol p.o. 100 mg/d at home. After being admitted to the hospital, without the physician’s knowledge, the patient continued to use tramadol from his own supply while being treated with tramadol s.c. 50 mg/d.
Abdominal pain	Drug addition	Amoxicillin and clavulanate was initiated although the patient reported allergy to amoxicillin.
Atrial fibrillation	Drug dose	Theophylline, 400 mg twice daily, was initiated in a patient older than 65 years.
Pyrexia	Drug substitution	Osveral 500 mg (Deferasirox) was ordered on admission, based on physician's assumption, instead of Osvaren 435 mg/235 mg (calcium acetate and magnesium carbonate).
Hypertension	Drug dose	Amlodipine, 20 mg/d, was ordered at admission (exceeding the maximum dose). Patient reported use of amlodipine 10 mg/d.
Rectal bleeding	Drug addition	Clarithromycin 500 mg was initiated without any indication.
Lung cancer	Drug addition	Ipratropium was initiated in therapy already containing tiotropium.