Cornish Patricia L, Knowles Sandra R, Marchesano Romina, Tam Vincent, Shadowitz Steven, Juurlink David N, Etchells Edward E
Department of Pharmacy, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
Arch Intern Med. 2005 Feb 28;165(4):424-9. doi: 10.1001/archinte.165.4.424.
Prior studies suggest that unintended medication discrepancies that represent errors are common at the time of hospital admission. These errors are particularly worthy of attention because they are not likely to be detected by computerized physician order entry systems.
We prospectively studied patients reporting the use of at least 4 regular prescription medications who were admitted to general internal medicine clinical teaching units. The primary outcome was unintended discrepancies (errors) between the physicians' admission medication orders and a comprehensive medication history obtained through interview. We also evaluated the potential seriousness of these discrepancies. All discrepancies were reviewed with the medical team to determine if they were intentional or unintentional. All unintended discrepancies were rated for their potential to cause patient harm.
After screening 523 admissions, 151 patients were enrolled based on the inclusion criteria. Eighty-one patients (53.6%; 95% confidence interval, 45.7%-61.6%) had at least 1 unintended discrepancy. The most common error (46.4%) was omission of a regularly used medication. Most (61.4%) of the discrepancies were judged to have no potential to cause serious harm. However, 38.6% of the discrepancies had the potential to cause moderate to severe discomfort or clinical deterioration.
Medication errors at the time of hospital admission are common, and some have the potential to cause harm. Better methods of ensuring an accurate medication history at the time of hospital admission are needed.
先前的研究表明，在医院入院时，代表错误的意外用药差异很常见。这些错误尤其值得关注，因为它们不太可能被计算机化医师医嘱录入系统检测到。
我们前瞻性地研究了入住普通内科临床教学单元、报告使用至少4种常规处方药的患者。主要结局是医师入院用药医嘱与通过访谈获得的全面用药史之间的意外差异（错误）。我们还评估了这些差异的潜在严重性。所有差异均与医疗团队进行审查，以确定它们是有意还是无意的。所有意外差异均根据其对患者造成伤害的可能性进行评级。
在筛选了523例入院病例后，根据纳入标准纳入了151例患者。81例患者（53.6%；95%置信区间，45.7%-61.6%）至少有1次意外差异。最常见的错误（46.4%）是遗漏常用药物。大多数（61.4%）差异被判定没有造成严重伤害的可能性。然而，38.6%的差异有可能导致中度至重度不适或临床恶化。
医院入院时的用药错误很常见，有些有可能造成伤害。需要更好的方法来确保入院时用药史的准确性。
