KEY POINTS:
Up to 70 per cent of the medication histories of elderly patients admitted to Auckland City Hospital have omissions or errors, a study has found.
Most of the mistakes were minor, but a third of the discrepancies could give rise to discomfort or potential harm, the Auckland University study found.
The study looked at 653 patients aged over 75 who were taking five or more medicines.
Twelve cases were potentially serious enough to "prolong hospital admission".
The finding follows the Health and Disability Commissioner's report into an Auckland diabetic's death after the hospital mixed a fax from his GP with the medical records of another patient. The man received a fatal combination of the wrong drugs.
Auckland City Hospital has apologised for the blunder, which hastened 82-year-old Mervin McAlpine's death in 2004, and said it had taken steps to correct the situation.
The case has brought calls for a better system to make sure patients receive the correct drugs.
Health Minister Pete Hodgson yesterday indicated that the Budget would set aside money to help create a barcode system to reduce the risk of patients receiving the wrong drugs.
"An important thing for us to think about is what we can do as a system to reduce mismedication issues," he said.
Dr Peter Black, who conducted the study, said the system was helpful but did not reduce the risk of a situation similar to that of Mr McAlpine's.
"That's an issue related to what happens once they're in hospital. What we're talking about here is problems with the interface of care, with medicines being listed incorrectly coming from out of hospital."
Dr Black said having a common electronic medication record would enable hospital staff to check medications listed with a patient's GP or pharmacist. And the pharmacist or GP would be able to check on drugs given in hospital.
A pilot study is being conducted, but software incompatibility between GP, pharmacy and hospital systems is a problem.
Dr Black said a common system would "really help with the sort of problem we're talking about".
"It's not the entire solution, because even if you have a common electronic medication record things may be recorded incorrectly, just as the patient being prescribed a medicine doesn't mean they're taking it."
Auckland City Hospital's chief medical officer, Dr David Sage, said that while changes had been made to correct the problems which led to Mr McAlpine's being prescribed the wrong drugs, "it hasn't cured everything".
"What it's done is substantially reduce the chance of that particular error of wrong medication occurring again," he said.
Dr Sage said that because there were so many steps in the use of medication, "a wide range of human error could creep into the process".
Computerised systems which used barcoding of patients and prevented the wrong drugs being prescribed or dispensed were expensive.
He said Auckland City Hospital computerised only the pharmacy-management side, and prescribing and dispensing remained manual.
The director of the social statistics research group at Auckland University, Dr Peter Davis, supported a common electronic medication record.
"Why fax information, when it can be appended to the electronic record?"
Dr Black said a study in Toronto had found about 60 per cent of the medication histories of elderly patients were recorded incorrectly.
It was a problem that had been known for some time, and patients aged over 75 and those on multiple medications were most at risk.
Dr Black's study, conducted between December 2006 and March this year, found a third of the discrepancies found in records had the potential to cause discomfort.
"We stress 'potential'. In this case they didn't, because they were identified. And even if they hadn't been picked up there's no guarantee they would've caused a problem ... "
- Additional reporting Martin Johnston
