Rodríguez Vargas Blanca, Delgado Silveira Eva, Iglesias Peinado Irene, Bermejo Vicedo Teresa
Pharmacy Department, Ramon y Cajal Hospital, Madrid, Spain.
Complutense University, Madrid, Spain.
Int J Clin Pharm. 2016 Oct;38(5):1164-71. doi: 10.1007/s11096-016-0348-8. Epub 2016 Aug 24.
Background Care transitions are risk points for medication discrepancies, especially in the elderly. Objective This study was undertaken to assess prevalence and describe medication reconciliation errors during admission in elderly patients and to analyze associated risk factors. We also evaluate the effect of these errors on the length of hospital stay. Setting General surgery, orthopedics, internal medicines and infectious diseases departments of a 1070-bed Spanish teaching hospital. Method This is a prospective observational study. Patients >65 years and taking ≥5 medications were randomly selected from those admitted to hospital. The pharmacist obtained the best possible medication history based on medical records, medical notes from patients' previous admissions to hospital, "brown bag" review, community care prescriptions, and comprehensive patient interviews. It was compared to current inpatient prescription to detect unintentional discrepancies (discrepancy with no apparent clinical explanation), which were reported to the physician. When the physician accepted the discrepancy by changing the medication order, it was recorded as a medication reconciliation error and classified by type of error. Several variables were analyzed as possible risk/protective factors. Main outcome measure Is prevalence of medication reconciliation errors at admission. Results Reconciliation was performed on 206 patients. Medication reconciliation errors occurred in 49.5 % (102/206) of patients. 1996 medications were recorded, and 359 had unintentional discrepancies (56.0 % (201/359) medication reconciliation errors). The most common was omission (65.1 %). Identified risk factors were as follows: physician experience, number of pre-admission prescribed medications, and previous surgeries. Computerized order entry system was a protective factor. Conclusion Medication reconciliation errors occur in almost half of the elderly patients at admission, especially omissions. Risk factors were a larger number of previous medications, less physician years of experience, and more previous surgeries. Having a computerized order entry system in the hospital protected against some errors.
背景 护理转接是用药差异的风险点，在老年人中尤为如此。目的 本研究旨在评估老年患者入院时用药核对错误的患病率并描述这些错误，同时分析相关风险因素。我们还评估了这些错误对住院时间的影响。地点 一家拥有1070张床位的西班牙教学医院的普通外科、骨科、内科和传染病科。方法 这是一项前瞻性观察性研究。从入院患者中随机选取年龄>65岁且服用≥5种药物的患者。药剂师根据病历、患者既往住院的医疗记录、“棕色纸袋”审查、社区护理处方以及全面的患者访谈，获取尽可能完善的用药史。将其与当前住院处方进行比较，以检测无意差异（无明显临床解释的差异），并向医生报告。当医生通过更改用药医嘱接受差异时，将其记录为用药核对错误，并按错误类型进行分类。分析了几个变量作为可能的风险/保护因素。主要结局指标 入院时用药核对错误的患病率。结果 对206例患者进行了核对。49.5%（102/206）的患者发生了用药核对错误。记录了1996种药物，其中359种存在无意差异（56.0%（201/359）为用药核对错误）。最常见的是遗漏（65.1%）。确定的风险因素如下：医生经验、入院前开具的药物数量以及既往手术史。计算机化医嘱录入系统是一个保护因素。结论 几乎一半的老年患者入院时发生用药核对错误，尤其是遗漏。风险因素包括既往用药数量较多、医生经验年限较少以及既往手术次数较多。医院拥有计算机化医嘱录入系统可预防一些错误。
