Clinical Research and Epidemiology Unit, University Hospital of Montpellier.
From the Clinical Pharmacy Department, University Hospital of Montpellier.
J Patient Saf. 2021 Oct 1;17(7):e645-e652. doi: 10.1097/PTS.0000000000000420.
First, the aim of the study was to assess the prevalence, characteristics, and severity of unintended medication discrepancies (UMDs) and medication errors (MEs) at admission and discharge of hospitalization. Second, the aim of the study was to identify clinical and hospitalization factors associated with risk of UMDs as well as characteristics of the medication reconciliation process associated with UMDs detection.
This prospective observational study included all adult patients admitted from 2013 to 2015 in the Endocrinology-Diabetology-Nutrition Department of Montpellier Hospital, France. Clinical pharmacists conducted medication reconciliation by collecting the best possible medication history from different sources and comparing it with admission and discharge prescriptions to identify discrepancies. Unintended medication discrepancies corrected by the physician were considered as MEs. Risk factors of UMDs were identified with logistic regression.
Of 904 patients included, 266 (29.4%) had at least one UMD, at admission or at discharge. In total, 378 (98.2%) of 385 UMDs were considered to be MEs. Most MEs were omissions (59.3%). Medication errors were serious or very serious in 36% of patients and had potentially moderate severity in almost 40% of patients. The risk of UMDs increased constantly with the number of treatments (P < 0.001). Thyroid (adjusted odds ratio [OR] = 1.79, 95% CI = 1.12-2.86) and infectious diseases (adjusted OR = 1.80, 95% CI = 1.17-2.78) were associated with UMDs risk at admission. The best type of source for the detection of UMDs was the general practitioner or nurse (OR = 2.64, 95% CI = 1.51-4.63).
Unintended medication discrepancies are frequent at hospital and depend on intrinsic clinical parameters but also on practice of medication reconciliation process, such as number and type of sources used.
首先，本研究旨在评估住院期间入院和出院时未预期药物差异（UMD）和用药错误（ME）的发生率、特征和严重程度。其次，本研究旨在确定与 UMD 风险相关的临床和住院因素，以及与 UMD 检测相关的药物重整过程的特征。
本前瞻性观察性研究纳入了 2013 年至 2015 年期间法国蒙彼利埃医院内分泌科、糖尿病科和营养科收治的所有成年患者。临床药师通过从不同来源收集尽可能完整的用药史，并将其与入院和出院医嘱进行比较来识别差异，从而进行药物重整以发现差异。经医生纠正的未预期药物差异被视为 ME。采用逻辑回归识别 UMD 的危险因素。
在 904 名纳入患者中，266 名（29.4%）在入院或出院时至少存在一种 UMD。在总共 385 例 UMD 中，378 例（98.2%）被认为是 ME。大多数 ME 为漏用（59.3%）。36%的患者 ME 为严重或非常严重，近 40%的患者 ME 具有潜在的中度严重程度。随着治疗数量的增加，UMD 的风险不断增加（P < 0.001）。甲状腺疾病（调整后的比值比[OR] = 1.79，95%置信区间[CI] = 1.12-2.86）和传染病（调整后的 OR = 1.80，95% CI = 1.17-2.78）与入院时的 UMD 风险相关。检测 UMD 的最佳来源类型是全科医生或护士（OR = 2.64，95% CI = 1.51-4.63）。
住院期间 UMD 很常见，这取决于内在的临床参数，也取决于药物重整过程的实践，如使用的来源数量和类型。
