Villanyi Diane, Fok Mark, Wong Roger Y M
Department of Medicine, Division of Geriatric Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Am J Geriatr Pharmacother. 2011 Oct;9(5):339-44. doi: 10.1016/j.amjopharm.2011.07.005. Epub 2011 Sep 3.
Medication discrepancies may occur during transitions from community to acute care hospitals. The elderly are at risk for such discrepancies due to multiple comorbidities and complex medication regimens. Medication reconciliation involves verifying medication use and identifying and rectifying discrepancies.
The aim of this study was to describe the prevalences and types of medication discrepancies in acutely ill older patients.
Patients who were ≥ 70 years and were admitted to any of 3 acute care for elders (ACE) units over a period of 2 nonconsecutive months in 2008 were prospectively enrolled. Medication discrepancies were classified as intentional, undocumented intentional, and unintentional. Unintentional medication discrepancies were classified by a blinded rater for potential to harm. This study was primarily qualitative, and descriptive (univariate) statistics are presented.
Sixty-seven patients (42 women; mean [SD] age, 84.0 [6.5] years) were enrolled. There were 37 unintentional prescription-medication discrepancies in 27 patients (40.3%) and 43 unintentional over-the-counter (OTC) medication discrepancies in 19 patients (28.4%), which translates to Medication Reconciliation Success Index (MRSI) of 89% for prescription medications and 59% for OTC medications. The overall MRSI was 83%. More than half of the prescription-medication discrepancies (56.8%) were classified as potentially causing moderate/severe discomfort or clinical deterioration.
Despite a fairly high overall MRSI in these patients admitted to ACE units, a substantial proportion of the prescription-medication discrepancies were associated with potential harm.
从社区医院转至急症医院期间可能会出现用药差异。由于多种合并症和复杂的用药方案，老年人存在出现此类差异的风险。用药核对包括核实用药情况并识别和纠正差异。
本研究旨在描述急症老年患者用药差异的发生率和类型。
前瞻性纳入2008年连续2个非连续月份入住3个老年急症护理（ACE）单元中任何一个单元的70岁及以上患者。用药差异分为有意、未记录的有意和无意。由一名不知情的评估者对无意用药差异的潜在危害进行分类。本研究主要是定性的，并呈现描述性（单变量）统计数据。
共纳入67例患者（42例女性；平均[标准差]年龄，84.0[6.5]岁）。27例患者（40.3%）存在37例无意的处方药差异，19例患者（28.4%）存在43例无意的非处方药（OTC）差异，这意味着处方药的用药核对成功指数（MRSI）为89%，非处方药为59%。总体MRSI为83%。超过一半的处方药差异（56.8%）被归类为可能导致中度/重度不适或临床恶化。
尽管入住ACE单元的这些患者总体MRSI相当高，但相当一部分处方药差异与潜在危害相关。
