Clinical Pharmacy Department, University Hospital of Montpellier, France.
PhyMedExp, University of Montpellier, INSERM U1046, CNRS, UMR 9214, France.
Diabet Med. 2017 Dec;34(12):1742-1746. doi: 10.1111/dme.13531.
To assess the prevalence and characteristics of medication errors at hospital admission and discharge in people with Type 1 and Type 2 diabetes, and identify potential risk factors for these errors.
This prospective observational study included all people with Type 1 (n = 163) and Type 2 diabetes (n = 508) admitted to the Diabetology-Department of the University Hospital of Montpellier, France, between 2013 and 2015. Pharmacists conducted medication reconciliation within 24 h of admission and at hospital discharge. Medication history collected from different sources (patient/family interviews, prescriptions/medical records, contact with community pharmacies/general practitioners/nurses) was compared with admission and discharge prescriptions to detect unintentional discrepancies in medication indicating involuntary medication changes. Medication errors were defined as unintentional medication discrepancies corrected by physicians. Risk factors for medication errors and serious errors (i.e. errors that may cause harm) were assessed using logistic regression.
A total of 322 medication errors were identified and were mainly omissions. Prevalence of medication errors in Type 1 and Type 2 diabetes was 21.5% and 22.2% respectively at admission, and 9.0% and 12.2% at discharge. After adjusting for age and number of treatments, people with Type 1 diabetes had nearly a twofold higher odds of having medication errors (odds ratio (OR) 1.72, 95% confidence interval (CI) 1.02-2.94) and serious errors (OR 2.17, 95% CI 1.02-4.76) at admission compared with those with Type 2 diabetes.
Medication reconciliation identified medication errors in one third of individuals. Clinical pharmacists should focus on poly-medicated individuals, but also on other high-risk people, for example, those with Type 1 diabetes.
评估 1 型和 2 型糖尿病患者入院和出院时药物错误的发生率和特点，并确定这些错误的潜在风险因素。
这项前瞻性观察研究纳入了 2013 年至 2015 年期间在法国蒙彼利埃大学医院内分泌科住院的 163 例 1 型和 508 例 2 型糖尿病患者。药剂师在入院后 24 小时内和出院时进行药物重整。从不同来源（患者/家属访谈、处方/病历、与社区药房/全科医生/护士联系）收集的药物史与入院和出院处方进行比较，以发现药物使用中的非故意差异，这些差异表明药物使用发生了非自愿的改变。药物错误被定义为医生纠正的非故意药物差异。使用逻辑回归评估药物错误和严重错误（即可能导致伤害的错误）的风险因素。
共发现 322 例药物错误，主要为遗漏。1 型和 2 型糖尿病患者入院时药物错误的发生率分别为 21.5%和 22.2%，出院时分别为 9.0%和 12.2%。调整年龄和治疗数量后，与 2 型糖尿病患者相比，1 型糖尿病患者入院时发生药物错误（比值比（OR）1.72，95%置信区间（CI）1.02-2.94）和严重错误（OR 2.17，95% CI 1.02-4.76）的可能性几乎高出两倍。
药物重整确定了三分之一个体的药物错误。临床药师应关注多药物治疗个体，但也应关注其他高风险人群，例如 1 型糖尿病患者。
