Talebi Mohammad Mehdi, Sefidani Forough Aida, Riazi Esfahani Parsa, Eskandari Raha, Haghgoo Roodabeh, Fahimi Fanak
Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Irvine Valley College, Irvine, CA, USA.Tehran, Iran.
Iran J Pharm Res. 2018 Winter;17(Suppl):159-167.
Medication interactions are associated with various unwanted adverse drug reactions. Medication Reconciliation involves a process in which a complete list of patient's previously prescribed medications are recorded and subsequently evaluated within the context of concomitantly prescribed medications and present medical condition during the hospitalization. Medical records of randomly selected 270 patients hospitalized in internal medicine, cardiovascular and infectious diseases wards were evaluated. Drug interactions were checked by LexiComp® database. Each interaction was assigned a risk rating of A, B, C, D, or X. The progression from A to X was based on increased urgency for responding to the data. Completed reconciliation forms were attached to patient charts for evaluation of physicians' compliance. Drug interactions were observed in 65.2% (176/270) of cases. The risk rating of interactions was categorized as C, D and X in 54.2%, 32.4%, and 13.4% of cases, respectively. There was a positive correlation between the number of prescribed medications and the rate of interactions (-value < 0.001, Kendall's correlation coefficient = 0.487). Moreover, the length of hospitalization and the rate of drug interactions were significantly correlated (-value < 0.001, Kendall's correlation coefficient = 0.350). Cardiovascular agents constituted the largest proportion of interactions (25%) followed by antibiotics (18%) and immunosuppressive agents (6%). In 59.6% of cases, no corrective action was taken by the physicians. Medication discrepancies occur commonly in hospital settings. Structured medication reconciliation may have a positive impact on prevention of medication errors.
药物相互作用与各种不良药物不良反应相关。用药核对涉及一个过程，即记录患者先前开具的所有药物清单，并随后在住院期间同时开具的药物和当前医疗状况的背景下进行评估。对在内科、心血管和传染病病房住院的270名随机选择患者的病历进行了评估。通过LexiComp®数据库检查药物相互作用。每种相互作用都被赋予A、B、C、D或X的风险等级。从A到X的进展是基于对数据做出反应的紧迫性增加。完整的核对表单附在患者病历上，以评估医生的依从性。在65.2%（176/270）的病例中观察到药物相互作用。相互作用的风险等级分别在54.2%、32.4%和13.4%的病例中被分类为C、D和X。开具的药物数量与相互作用发生率之间存在正相关（P值<0.001，肯德尔相关系数=0.487）。此外，住院时间与药物相互作用发生率显著相关（P值<0.001，肯德尔相关系数=0.350）。心血管药物构成相互作用的最大比例（25%），其次是抗生素（18%）和免疫抑制剂（6%）。在59.6%的病例中，医生未采取纠正措施。用药差异在医院环境中很常见。结构化的用药核对可能对预防用药错误有积极影响。
