From the Hospital Pharmacy, Fondazione Toscana G. Monasterio, Heart Hospital, Massa.
Clinical Risk Management and Patient Safety Center, Tuscany Region, Florence.
J Patient Saf. 2021 Apr 1;17(3):e143-e148. doi: 10.1097/PTS.0000000000000360.
Medication errors are one of the leading causes of patient harms. Medication reconciliation is a fundamental process that to be effective, it should be embraced during each single care transition. Our objectives were to investigate current medication reconciliation practices in the 2 Fondazione Toscana Gabriele Monasterio hospitals and comprehensively assess the quality of medication reconciliation practices between inpatient and outpatient care by analyzing the medication patterns 6 months before admission, during hospitalization, and 9 months after discharge for a selected group of patients with cardiovascular diseases.
A retrospective observational study was conducted in the Cardiothoracic Department of the Fondazione Toscana Gabriele Monasterio hospitals. Medication history was reviewed for all the patients admitted from and discharged to the community, from January to March 2013. Patients were excluded if they had less than 4 drugs or less than 2 drugs for cardiovascular system in their prescription list at admission or if they died during follow-up. We selected 714 patients, and we obtained the clinical charts and all drug prescriptions collected during patients' hospitalization by the electronic clinical recording system. We also analyzed the list of prescriptions of this sample of patients, from 6 months before admission to 9 months after discharge, extracted from the regional prescription registry. In the resulting sample, prescriptions were analyzed to assess unintentional discrepancies.
The study included 298 patients (mean age, 71.2 years), according to the inclusion and exclusion criteria. Among 14,573 prescriptions analyzed, we found 4363 discrepancies (14.6 discrepancies per patient). Among these discrepancies, 1310 were classified as unintentional (4.4 discrepancies per patient). Among unintentional discrepancies, only 63 (4.8%) took place during hospitalization. Although at the hospital-home interface, 33.1% of unintentional discrepancies were detected through the comparison between the patients' declared therapy and the previous medication consumption and 62.1% were identified in the comparison between the prescription at the discharge and the following medication pattern at home.
Medication errors have important implications for patient safety, and their identification is a main target for improving clinical practice. The comparison between the medication patterns acquired through the regional prescription registry before and after hospitalization outlined critical touchpoint in the current medication reconciliation process, calling for the definition of shared medication reconciliation standards between hospitals and primary care services to minimize medication discrepancies and enhance patient safety.
用药错误是导致患者伤害的主要原因之一。用药核对是一个基本的过程，为了使其有效，应该在每次医疗过渡期间都进行。我们的目标是调查 2 家 Fondazione Toscana Gabriele Monasterio 医院目前的用药核对实践，并通过分析选定心血管疾病患者入院前 6 个月、住院期间和出院后 9 个月的用药模式，全面评估住院和门诊护理之间的用药核对实践质量。
在 Fondazione Toscana Gabriele Monasterio 医院的心胸科进行了一项回顾性观察研究。对 2013 年 1 月至 3 月期间从社区入院和出院的所有患者进行了用药史回顾。如果患者入院时的处方清单中药物少于 4 种或心血管系统药物少于 2 种，或者在随访期间死亡，则将其排除在外。我们选择了 714 名患者，并通过电子临床记录系统获得了他们在住院期间的临床病历和所有药物处方。我们还分析了从入院前 6 个月到出院后 9 个月这一样本患者的处方清单，这些处方清单从地区处方登记处提取。在最终的样本中，对处方进行了分析，以评估非故意差异。
根据纳入和排除标准，该研究共纳入 298 名患者（平均年龄 71.2 岁）。在分析的 14573 份处方中，我们发现了 4363 处差异（每位患者 14.6 处差异）。在这些差异中，1310 处被归类为非故意差异（每位患者 4.4 处差异）。在非故意差异中，只有 63 处（4.8%）发生在住院期间。尽管在医院-家庭交接点，通过比较患者所申报的治疗方法和之前的药物使用情况，发现了 33.1%的非故意差异，而通过比较出院时的处方和在家中的后续用药模式，发现了 62.1%的非故意差异。
用药错误对患者安全有重要影响，识别这些错误是改善临床实践的主要目标。通过比较从地区处方登记处获得的入院前和入院后的用药模式，确定了当前用药核对过程中的关键接触点，需要在医院和初级保健服务之间定义共享用药核对标准，以最大限度地减少用药差异并提高患者安全性。
