Salameh Lana, Abu Farha Rana, Basheti Iman
Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan.
Saudi Pharm J. 2018 Jan;26(1):125-132. doi: 10.1016/j.jsps.2017.10.002. Epub 2017 Oct 3.
Medication errors are considered among the most common causes of morbidity and mortality in hospital setting. Among these errors are discrepancies identified during transfer of patients from one care unit to another, from one physician care to another, or upon patient discharge. Thus, the aims of this study were to identify the prevalence and types of medication discrepancies at the time of hospital admission to a tertiary care teaching hospital in Jordan and to identify risk factors affecting the occurrence of these discrepancies.
A three months prospective observational study was conducted at the department of internal medicine at Jordan university hospital. During the study period, 200 patients were selected using convenience sampling, and a pre-prepared data collection form was used for data collection. Later, a comparison between the pre-admission and admission medication was conducted to identify any possible discrepancies, and all of these discrepancies were discussed with the responsible resident to classify them into intentional (documentation errors) or unintentional. Linear regression analysis was performed to assess risk factors associated with the occurrence of unintentional discrepancies.
A total of 412 medication discrepancies were identified at the time of hospital admission. Among them, 144 (35%) were identified as unintentional while the remaining 268 (65%) were identified as intentional discrepancies. Ninety-four patients (47%) were found to have at least one unintentional discrepancy and 92 patients (46%) had at least one documentation error. Among the unintentional discrepancies, 97 (67%) were found to be associated with a potential harm/deterioration to the patients. Increasing patients' age (beta = 0.195, p-value = .013) and being treated by female residents (beta = 0.139, p-value = .045) were significantly associated with higher number of discrepancies.
The prevalence of unintentional discrepancies at the time of hospital admission was alarmingly high. Majority of these discrepancies were associated with a potential harm to the patients. These findings support the necessity for implementing the medication reconciliation service in the country, engaging healthcare providers in the process of identification and resolution of medication discrepancies.
用药差错被认为是医院环境中发病和死亡的最常见原因之一。这些差错包括患者从一个护理单元转到另一个护理单元、从一位医生护理转到另一位医生护理或出院时发现的差异。因此,本研究的目的是确定约旦一家三级护理教学医院入院时用药差异的患病率和类型,并确定影响这些差异发生的风险因素。
在约旦大学医院内科进行了一项为期三个月的前瞻性观察研究。在研究期间,采用便利抽样法选取了200名患者,并使用预先准备好的数据收集表进行数据收集。随后,对入院前和入院时的用药情况进行比较,以确定任何可能的差异,并与负责的住院医生讨论所有这些差异,将其分为故意(记录错误)或非故意。进行线性回归分析以评估与非故意差异发生相关的风险因素。
入院时共发现412处用药差异。其中,144处(35%)被确定为非故意,其余268处(65%)被确定为故意差异。94名患者(47%)被发现至少有一处非故意差异,92名患者(46%)有至少一处记录错误。在非故意差异中,97处(67%)被发现与对患者的潜在伤害/病情恶化有关。患者年龄增加(β = 0.195,p值 = 0.013)和由女性住院医生治疗(β = 0.139,p值 = 0.045)与差异数量较多显著相关。
入院时非故意差异的患病率高得惊人。这些差异中的大多数与对患者的潜在伤害有关。这些发现支持了在该国实施用药核对服务的必要性,让医疗保健提供者参与用药差异的识别和解决过程。