Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.
J Cardiovasc Pharmacol. 2009 Dec;54(6):497-501. doi: 10.1097/FJC.0b013e3181be75b4.
Medication errors may occur when hospital doctors are not adequately informed about a patient's prescribed drugs.
The drug lists of 103 patients who were electively admitted for coronary angiography were assessed. Discrepancies between lists noted in admission letters, patient's personal medication lists, and medication histories were analyzed.
Patients took a mean of 5 +/- 3 drugs. Nine percent of all drugs taken were only mentioned when a systematic medication history was obtained but were not stated in admission letters or on medication lists. Only 88% of admission letters reported the patient's medication. Twenty-one percent of generics were incorrectly documented as originals in the admission letter. Less than 50% of patients taking >or= 4 drugs had a written instruction on how to take their medication. A total of 86 drugs actually taken by the patients were not identical to those listed in the referral letter or the medication list, leaving uncertainties as to how outpatient medication should be continued. Medication was modified in 25% of all patients at hospital discharge.
Instructions for patients taking multiple drugs and information in admission letters need to be improved. These results underline the importance of medication reconciliation at hospital admission.
当医院医生对患者的处方药物了解不充分时，可能会发生用药错误。
评估了 103 名择期行冠状动脉造影术的患者的药物清单。分析了入院信、患者个人用药清单和用药史中记录的差异。
患者平均服用 5 +/- 3 种药物。当进行系统的用药史采集时，有 9%的所有服用药物仅被提及，但未在入院信或药物清单中说明。只有 88%的入院信报告了患者的用药情况。21%的仿制药在入院信中错误地记录为原研药。服用 >or= 4 种药物的患者中，不到 50%的患者有书面的用药说明。实际上有 86 种患者正在服用的药物与转诊信或药物清单上列出的药物并不完全相同，这使得如何继续门诊用药存在不确定性。在所有出院患者中，有 25%的患者进行了药物调整。
需要改进服用多种药物的患者的医嘱和入院信中的信息。这些结果强调了在入院时进行用药核对的重要性。
