Inpatient topical glaucoma medication-ordering discrepancies: a study of frequency and risk factors for inaccurate reconciliation.

Abstract

Objective: To describe the frequency of topical glaucoma medication-ordering discrepancies (MOD) during transitions of care and to explore factors that may be associated with an increased risk of MOD.

Design: Retrospective cohort study.

Participants: A random sample of adult patients with primary open-angle glaucoma (POAG) on at least 1 topical glaucoma medication admitted to any Cleveland Clinic facility between January 1, 2012, to January 1, 2023. Study patients must have had at least 1 visit with a Cole Eye Institute ophthalmologist-who diagnosed POAG and prescribed one or more topical glaucoma medications-within 12 months prior to admission.

Methods: Charts were manually reviewed for discrepant prescriptions. Logistic regressions were employed to assess potential risk factors.

Results: MOD was noted in 288 of 944 (30.5%) encounters. Patient demographics, hospital site, provider type, admitting service, and pharmacy verification did not alter the odds of MOD. Patients on 3 medications experienced MOD most frequently (41.2%) followed by 1 medication (29.3%) and then 2 medications (26.8%) (P = 0.032). Omission was the most common MOD type across all reconciliations followed by substitution, addition, and wrong eye MOD (23.8%, 9.1%, 3.3%, and 0.53%, respectively). Medication discrepancy in a previous hospitalization increased the odds of discrepancy in the next (OR 5.1, 95% CI [3.2-8.4]; P < 0.001). A discrepancy on admission significantly increased MOD rates at transfer and discharge (P < 0.001).

Conclusions: Glaucoma MOD occurred in approximately one-third of the inpatient encounters in this study, suggesting incongruence at transitions of care. Patients with inpatient MOD were significantly more likely to have an MOD in subsequent admissions.