Complex Medication Reconciliation in the Danish Medication System: Shared Medication Record for patients in transition of care across sectors

Helene Tarp
Department of Health Science and Technology, Aalborg University, Aalborg, Denmark

Lili Worre Høpfner Jensen
Department of Health Science and Technology, Aalborg University, Aalborg, Denmark

Nikolaj Krabbe Jepsen
Department of Health Science and Technology, Aalborg University, Aalborg, Denmark

Mads Clausen
Department of Health Science and Technology, Aalborg University, Aalborg, Denmark

Nina Aagaard Madsen
Department of Health Science and Technology, Aalborg University, Aalborg, Denmark

Henrik Majkjær Marquart
Department of Health Science and Technology, Aalborg University, Aalborg, Denmark

Louise Pape-Haugaard
Department of Health Science and Technology, Aalborg University, Aalborg, Denmark

Ladda ner artikel

Ingår i: Proceedings from The 15th Scandinavian Conference on Health Informatics 2017 Kristiansand, Norway, August 29–30, 2017

Linköping Electronic Conference Proceedings 145:4, s. 21-27

Visa mer +

Publicerad: 2018-01-04

ISBN: 978-91-7685-364-1

ISSN: 1650-3686 (tryckt), 1650-3740 (online)


The purpose of Shared Medication (SMR) is to ensure medication reconciliation and thereby reduce the medication errors, thus increasing patient safety. However, medication errors concerning high-risk drugs as Warfarin remain a well-known issue in transitions of care. We examine if different ways of prescribing Warfarin in SMR affect patient safety in regards to transitions of care. We conducted a literature research and semi-structured interviews to investigate the objective. Data were analyzed based on the three analytical questions, and findings were synthesized. The findings indicate that implementing SMR has resulted in new errors. The medical order entry system allows for different manners to prescribe Warfarin which complicates reuse of information in primary sector. This can potentially jeopardize patient safety. Challenges using SMR in relation to the prescription of Warfarin creates workarounds which prevents a number of potential medication errors. But workarounds induce the risk of new undiscovered medication errors, which is why we argue for a higher degree of standardization in medication reconciliation of high risk drugs as Warfarin.


Patient Safety, Medication Reconciliation, Medication Systems, Hospital, Medication Systems, Medication Errors, Medical Order Entry Systems, Shared Medication Record


[1] Ash, J. S., Sittig, D. F., Poon, E. G., Guappone, K., Campbell, E. and Dykstra, R. H. 2007, ‘The extent and importance of unintended consequences related to computerized provider order entry.’, Journal of the American Medical Informatics Association : JAMIA.England, 14(4), pp. 415–423.

[2] Berg, M. 2001, ‘Implementing information systems in health care organizations: myths and challenges.’, International journal of medical informatics. Ireland,64(2–3), pp. 143–156.

[3] Dansk Patientsikkerhedsdatabase 2015, Risikosituationslaegemidler2015. Available at: http://www.dpsd.dk/Publikationer/Risikosituationslaegemidler/Listen overrisikosituationslaegemidler.aspx (Accessed: 20November 2016).

[4] Dansk patientsikkerhedsdatabase 2016, DPSD – Dansk Patient Sikkerheds Database - Listen over risikosituationslægemidler. Available at: http://www.dpsd.dk/Publikationer/Risikosituationslaegemidler/Listen overrisikosituationslaegemidler.aspx.

[5] Day, M., Malone, M., Burkeybile, A. and Deane, K.2016, ‘Improving Transitions of Care for Hospitalized Patients on Warfarin.’, Joint Commission journal on quality and patient safety. Netherlands, 42(9), pp.425–431.

[6] Enheden for Brugerundersøgelser, R. H. 2006, POPS: Patienters oplevelser i Overgange mellem Primær og Sekundær sektor. Available at: http://patientoplevelser.dk/sites/patientoplevelser.dk/files/dokumenter/artikel/pops_rapport.pdf (Accessed: 24 November 2016).

[7] Friedman, A., Crosson, J. C., Howard, J., Clark, E. C., Pellerano, M., Karsh, B.-T., Crabtree, B., Jaén, C. R. and Cohen, D. J. 2014, ‘A typology of electronic health record workarounds in small-to-medium size primary care practices.’, Journal of the American Medical Informatics Association : JAMIA, 21(e1), pp. 78-83.

[8] Garrett, T. and McCormack, C. 2014, ‘Does an Electronic Discharge Referral System Improve the Quality of Medication Prescribing?’, Journal of pharmacy practice and research. Wiley Blackwell,44(1), pp. 29–34.

[9] Hevner, A. R., March, S. T., Park, J. and Ram, S. 2004, ‘Design Science in Information System Research’, MIS Quarterly. MIS Quarterly, 28(1), pp. 75–105. Available at: http://search.ebscohost.com/login.aspx?direct=true&db=buh&AN=12581935&site=ehost-live.

[10] Lægemiddelstyrelsen 2011, Rapport om laegemidler involveret i alvorlige utilsigtede haendelser. Available at: https://laegemiddelstyrelsen.dk/~/media/66FDE301FBA44BDD96BA099589A513EE.ashx (Accessed: 24November 2016).

[11] Magrabi, F., Aarts, J., Nohr, C., Baker, M., Harrison, S., Pelayo, S., Talmon, J., Sittig, D. F. and Coiera, E. 2013,‘ A comparative review of patient safety initiatives for national health information technology’, International Journal of Medical Informatics, 82, pp. 139–148.

[12] McLeod, L. A. 2013, ‘Patient transitions from in patient to outpatient: Where are the risks? Can we address them?’, Journal of Healthcare Risk Management. John Wiley & Sons, Inc., 32(3), pp. 13–19.

[13] National Sundheds-it and MedCom 2011, ‘FællesMedicinkort : en fremtid med adgang til et fælles og samlet overblik over en borgers aktuelle medicinering’. København: National Sundheds-it, p.24. Available at: http://www.medcom.dk/dwn4450.

[14] NSI 2016, Fælles Medicinkort - Dokumentation.Available at: http://wiki.fmk.netic.dk/doku.php (Accessed: 10 November 2016).

[15] Patientombuddet 2012, Patientombuddet -Utilsigtede hændelser i medicineringsprocessen - hvadgik der galt, og hvad kan vi gøre? Available at: https://stps.dk/da/udgivelser/2012/~/media/440FB91BAA67485896ED799C84040955.ashx (Accessed: 24November 2016).

[16] Rigsrevisionen 2014, Beretning om problemerne medat udvikle og implementere fælles medicinkort. Kbh.: Statsrevisorerne, pp. 1-61.

[17] Rigsrevisionen 2016, ‘Problemerne med at udvikle og implementere Fælles Medicinkort’. København: Statsrevisorerne, pp. 1–58.

[18] Statens Seruminstitut and National sundheds it 2014, Det Fælles Medicinkort - Snitfladebeskrivelse version1.2.6. Available at: http://wiki.fmk.netic.dk/lib/exe/fetch.php?media=fmk:1.2.6:fmk_-_snitfladebeskrivelse_1.2.6.13.pdf (Accessed: 28 November 2016).

[19] Steichen, O. and Gregg, W. 2015, ‘Health Information Technology Coordination to Support Patient-centered Care Coordination.’, Yearbook of medical informatics. Germany, 10(1), pp. 34–37.

[20] Styrelsen for Patientsikkerhed 2015, ‘Dansk Patientsikkerhedsdatabase Årsberetning 2015’. København, p. 61. Available at: http://www.dpsd.dk/~/media/Foundry/Sites/DPSD/Files/Aarsrapporter/DPSD AArsberetning 2015.ashx (Accessed: 24 November 2016).

[21] Sundhedsstyrelsen 2003, ‘Meddelelse vedrørende fejlmedicinering i forbindelse med blodfortyndende behandling ( AK-behandling ).’ København, pp. 4–5.

[22] Sundhedsstyrelsen 2005, ‘Temarapport 2005:Medicinering’. København, p. 31. Available at: http://www.dpsd.dk/~/media/Foundry/Sites/DPSD/Files/me

[23] Sundhedsstyrelsen 2007, ‘Temarapport 2007: Risikomedicin Præparater som er involveret i faktuelle og potentielle SAC 3 hændelser’. København, pp. 1–43.

[24] Sygehusapoteket Region Nordjylland 2015, ‘Utilsigtede medicineringshændelser i 2015’. Aalborg,p. 3. Available at: http://www.rn.dk/~/media/Rn_dk/OmRegionNordjylland/Organisationsbeskrivelse/Sygehusapoteket/Lægemiddel Nyt 2016/20160610 UTH ogMarevan.ashx (Accessed: 7 December 2016).

[25] Turchin, A., Shubina, M. and Goldberg, S. 2011,‘Unexpected Effects of Unintended Consequences:EMR Prescription Discrepancies and Hemorrhage in Patients on Warfarin’, AMIA Annual Symposium Proceedings. American Medical Informatics Association, 2011, pp. 1412–1417. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3243204/.

[26] Zwaanswijk, M., Verheij, R. A., Wiesman, F. J. and Friele, R. D. 2011, ‘Benefits and problems of electronic information exchange as perceived by health care professionals: an interview study.’, BMC health services research. England, 11, p. 256.

Citeringar i Crossref