Division of Quality and Operations, Department of Clinical Quality Management, Northwestern Memorial Hospital, Chicago, IL 60611, USA.
J Gen Intern Med. 2010 May;25(5):441-7. doi: 10.1007/s11606-010-1256-6. Epub 2010 Feb 24.
This study was designed to determine risk factors and potential harm associated with medication errors at hospital admission.
Study pharmacist and hospital-physician medication histories were compared with medication orders to identify unexplained history and order discrepancies in 651 adult medicine service inpatients with 5,701 prescription medications. Discrepancies resulting in order changes were considered errors. Logistic regression was used to analyze the association of patient demographic and clinical characteristics including patients' number of pre-admission prescription medications, pharmacies, prescribing physicians and medication changes; and presentation of medication bottles or lists. These factors were tested after controlling for patient demographics, admitting service and severity of illness.
Over one-third of study patients (35.9%) experienced 309 order errors; 85% of patients had errors originate in medication histories, and almost half were omissions. Cardiovascular agents were commonly in error (29.1%). If undetected, 52.4% of order errors were rated as potentially requiring increased monitoring or intervention to preclude harm; 11.7% were rated as potentially harmful. In logistic regression analysis, patient's age > or = 65 [odds ratio (OR), 2.17; 95% confidence interval (CI), 1.09-4.30] and number of prescription medications (OR, 1.21; 95% CI, 1.14-1.29) were significantly associated with errors potentially requiring monitoring or causing harm. Presenting a medication list (OR, 0.35; 95% CI, 0.19-0.63) or bottles (OR, 0.55; 95% CI, 0.27-1.10) at admission was beneficial.
Over one-third of the patients in our study had a medication error at admission, and of these patients, 85% had errors originate in their medication histories. Attempts to improve the accuracy of medication histories should focus on older patients with a large number of medications. Primary care physicians and other clinicians should help patients utilize and maintain complete, accurate and understandable medication lists.
本研究旨在确定与入院时药物错误相关的风险因素和潜在危害。
药师和医院医生的用药史与医嘱进行比较，以确定 651 名成年内科住院患者的 5701 份处方药物中无法解释的用药史和医嘱差异。导致医嘱改变的差异被认为是错误。采用 logistic 回归分析患者人口统计学和临床特征与药物错误的关系，包括患者入院前的处方药物数量、药房、开方医生和药物变化；以及药物清单或药瓶的出示。在控制患者人口统计学、入院科室和疾病严重程度后，对这些因素进行了测试。
超过三分之一的研究患者（35.9%）出现 309 次医嘱错误；85%的错误源自用药史，近一半为遗漏。心血管药物最常出错（29.1%）。如果未被发现，52.4%的医嘱错误被认为可能需要增加监测或干预以防止危害；11.7%被认为可能有害。在 logistic 回归分析中，患者年龄≥65 岁[比值比（OR），2.17；95%置信区间（CI），1.09-4.30]和处方药物数量（OR，1.21；95% CI，1.14-1.29）与需要监测或可能造成伤害的潜在错误显著相关。入院时出示药物清单（OR，0.35；95% CI，0.19-0.63）或药瓶（OR，0.55；95% CI，0.27-1.10）是有益的。
我们的研究中有超过三分之一的患者在入院时发生药物错误，其中 85%的错误源自他们的用药史。为了提高用药史的准确性，应重点关注有大量药物的老年患者。初级保健医生和其他临床医生应帮助患者使用和维持完整、准确和易于理解的药物清单。
