Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, 205-02, Malmö, Sweden.
Int J Clin Pharm. 2012 Feb;34(1):113-9. doi: 10.1007/s11096-011-9599-6. Epub 2011 Dec 30.
To assess the impact of medication reconciliation interventions on medication error rates when elderly patients are discharged from hospital to community care or nursing homes.
Elderly patients (>65 years) living in nursing homes or in their own homes with care provided by the community nursing system.
All medical records containing information on drug treatment were collected from hospital departments, the community care service and GPs. We then identified if there were any changes in the transfer of information i.e. if the drugs were not the same as before the transfer. Two different persons independently evaluated all information about the patients' drugs to identify medication errors for three different time periods. During all three periods structured discharge information was used. In period 2, electronic medication lists were introduced and in period 3 we introduced specific routines and support by a clinical pharmacist to ensure prescription in the specific medication dispensing system (ApoDos). Asymptotic Linear by-Linear Association Test was used to compare number of medication errors in period 1, 2 and 3 respectively.
Number of medication errors per patient.
A total of 123 patients were evaluated at discharge. For the 109 patients using the ApoDos system, there were significant differences in the number of medication errors between period 1 and 3 (P = 0.048), period 2 and 3 (P = 0.037 but not between period 1 and 2 (P = 0.41). The mean numbers of errors were 1.5, 1.1 and 0.5 for period 1, 2 and 3 respectively. The 14 patients not using the ApoDos system had on average 0.4 errors per patient. Among the 58 patients with medication errors, 34 were evaluated as having low clinical risk, 22 moderate, and 2 high clinical risk.
Medication errors are still common when elderly patients are transferred from hospital to community/primary care. The main risk factor seems to be the specific medication dispensing system (ApoDos) or rather the process on how to use it. When this system was supported by clinical pharmacists, the error rate dropped to the same level as for patients without ApoDos.
评估在老年患者从医院转至社区护理或疗养院时，药物重整干预对药物错误率的影响。
居住在疗养院或由社区护理系统提供护理的家中的老年患者（>65 岁）。
从医院科室、社区护理服务和全科医生处收集包含药物治疗信息的所有医疗记录。然后，我们确定信息是否有任何变化，即转移前后的药物是否相同。两名不同的人员独立评估所有患者药物信息，以确定三个不同时期的药物错误。在所有三个时期都使用了结构化的出院信息。在第二期引入了电子药物清单，在第三期引入了具体的常规和临床药剂师的支持，以确保在特定药物配药系统（ApoDos）中开具处方。使用渐近线性线性关联检验比较第 1、2 和 3 期的药物错误数量。
每位患者的药物错误数量。
共评估了 123 名出院患者。对于使用 ApoDos 系统的 109 名患者，第 1 期和第 3 期（P = 0.048）、第 2 期和第 3 期（P = 0.037）之间的药物错误数量存在显著差异，但第 1 期和第 2 期之间无差异（P = 0.41）。第 1、2 和 3 期的平均错误数分别为 1.5、1.1 和 0.5。未使用 ApoDos 系统的 14 名患者平均每人有 0.4 个错误。在 58 名有药物错误的患者中，34 名被评估为低临床风险，22 名中风险，2 名高风险。
当老年患者从医院转至社区/初级保健时，药物错误仍然很常见。主要的风险因素似乎是特定的药物配药系统（ApoDos），或者说是使用它的过程。当该系统得到临床药师的支持时，错误率降至与没有 ApoDos 的患者相同的水平。
