Alfaro-Lara Eva Rocío, Santos-Ramos Bernardo, González-Méndez Ana Isabel, Galván-Banqueri Mercedes, Vega-Coca María Dolores, Nieto-Martín María Dolores, Ollero-Baturone Manuel, Pérez-Guerrero Concepción
Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, España.
Rev Esp Geriatr Gerontol. 2013 May-Jun;48(3):103-8. doi: 10.1016/j.regg.2012.11.011. Epub 2013 Mar 23.
To determine the incidence of medication errors when admitting patients with multiple chronic conditions to hospital, using a standard method.
A prospective, observational study was conducted on patients with multiple chronic conditions admitted to a tertiary hospital. The medication reconciliation was performed using the standard method considered the most suitable for these patients by an expert panel, following the Delphi methodology. The main information source used for this was the computerised clinical notes, both in primary care and in the hospital, recurring to a clinical interview if necessary. Discrepancies justified by the clinician, as well as reconciliation errors were recorded. The type of error and the pharmacological group involved were analysed and the seriousness of each one of them was assessed.
A total of 114 patients were included, with reconciliation errors being found in 75.4% of cases. The patients had 1397 prescribed drugs, of which 234 had discrepancies that required clarification by the clinician responsible. The clinician modified the prescription in 184 of these discrepancies, which were considered reconciliation errors. The types of error were: medication omission (139), commission (9), dose, prescription or different routes (24) and by incomplete prescription (12). Anti-anaemic drugs, vitamins, and psychoanaleptics were among the pharmacotherapeutic groups most affected by the errors.
The percentage of patients with multiple chronic conditions with errors is elevated. The development of methods particularly directed at patients with multiple chronic conditions manages to detect and decrease a high percentage of medication errors associated with changes of care levels.
采用一种标准方法确定患有多种慢性病的患者入院时用药错误的发生率。
对一家三级医院收治的患有多种慢性病的患者进行了一项前瞻性观察研究。按照德尔菲法，由一个专家小组采用被认为最适合这些患者的标准方法进行用药核对。主要信息来源是基层医疗和医院的计算机化临床记录，必要时通过临床访谈获取信息。记录临床医生认定合理的差异以及核对错误。分析错误类型和涉及的药物类别，并评估每种错误的严重程度。
共纳入114例患者，75.4%的病例存在核对错误。患者共开具了1397种处方药，其中234种存在差异，需要负责的临床医生进行澄清。临床医生对其中184种差异修改了处方，这些被视为核对错误。错误类型包括：漏服药物（139例）、误服（9例）、剂量、处方或用药途径不同（24例）以及处方不完整（12例）。抗贫血药、维生素和精神振奋药是受错误影响最大的药物治疗类别。
患有多种慢性病的患者中出现错误的比例较高。针对患有多种慢性病的患者开发的方法能够检测并减少与护理级别变化相关的高比例用药错误。
