Pharmacy Department, Hospital Universitario Doctor Peset, Valencia, Spain.
Ann Pharmacother. 2010 Nov;44(11):1747-54. doi: 10.1345/aph.1P184. Epub 2010 Oct 5.
Medication discrepancies, defined as unexplained variations among drug regimens at care transitions, are common. Some are unintended and cause reconciliation errors that are potentially detrimental for patients.
To determine the prevalence of medication discrepancies and reconciliation errors at admission and discharge in hospitalized patients and explore risk factors for reconciliation errors and their potential clinical impact.
An observational prospective study was conducted at a general teaching hospital. Patients who were admitted to the internal medicine service and were receiving chronic preadmission treatment were included in the study. Preadmission treatment was compared with the treatment prescribed on admission (first 48 hours) and at hospital discharge, and discrepancies and reconciliation errors were identified. The primary endpoint was the presence of reconciliation errors at admission and/or discharge. Potential risk factors (patient-, medication-, and system-related) for reconciliation errors were analyzed using a multivariate logistic regression model.
Of the 120 patients enrolled in the study between April and August 2009, 109 (90.8%) showed 513 discrepancies. The prevalence of patients with reconciliation errors was 20.8% (95% CI 13.6 to 28.1). Intended medication discrepancies were more frequent at admission (96.6%) than at discharge (75.5%), while reconciliation errors were more frequent at discharge (24.5%) than at admission (3.4%). The prevalence ratio (admission vs discharge) was 2.4 (95% CI 1.9 to 3.0) for discrepancies and 0.65 (95% CI 0.32 to 1.32) for reconciliation errors. The logistic regression analysis revealed an association between the number of discrepancies at admission (OR 1.21; 95% CI 1.01 to 1.44) and age (OR 1.05; 95% CI 0.99 to 1.10) and an increased risk of reconciliation errors.
Medication reconciliation strategies should focus primarily on avoiding errors at discharge. Since medication discrepancies at admission may predispose patients to reconciliation errors, early detection of such discrepancies would logically reduce the risk of reconciliation errors. Medication reconciliation programs must implement a process for gathering accurate preadmission drug histories and must submit this information to a critical assessment of patients' needs.
药物差异是指在医疗交接时药物方案之间无法解释的变化，这种情况很常见。其中一些差异是无意的，会导致潜在对患者有害的药物重整错误。
确定住院患者入院和出院时药物差异和药物重整错误的发生率，并探讨药物重整错误的危险因素及其潜在临床影响。
在一家综合教学医院进行了一项观察性前瞻性研究。研究纳入了被收入内科病房并正在接受慢性入院前治疗的患者。入院前治疗与入院后前 48 小时（首次治疗）和出院时的治疗进行了比较，并确定了差异和药物重整错误。主要终点是入院和/或出院时是否存在药物重整错误。使用多变量逻辑回归模型分析了药物重整错误的潜在危险因素（患者、药物和系统相关因素）。
2009 年 4 月至 8 月期间，共纳入了 120 例患者，其中 109 例（90.8%）患者有 513 种药物差异。有药物重整错误的患者比例为 20.8%（95%CI 13.6%至 28.1%）。与出院时（75.5%）相比，入院时（96.6%）更常出现有意的药物差异，而与入院时（3.4%）相比，出院时（24.5%）更常出现药物重整错误。差异的患病率比（入院时比出院时）为 2.4（95%CI 1.9 至 3.0），药物重整错误的患病率比为 0.65（95%CI 0.32 至 1.32）。逻辑回归分析显示，入院时的药物差异数量（OR 1.21；95%CI 1.01 至 1.44）和年龄（OR 1.05；95%CI 0.99 至 1.10）与药物重整错误的风险增加有关。
药物重整策略应主要侧重于避免出院时的错误。由于入院时的药物差异可能使患者容易发生药物重整错误，因此逻辑上，早期发现此类差异可降低药物重整错误的风险。药物重整计划必须制定一个收集准确入院前药物史的流程，并将这些信息提交给对患者需求的关键评估。
