Mazhar Faizan, Haider Nafis, Ahmed Al-Osaimi Yousif, Ahmed Rafeeque, Akram Shahzad, Carnovale Carla
Unit of Clinical Pharmacology Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, Milan, Italy.
Department of Basic Medical Science, Prince Sultan Military College of Health Sciences, King Fahd Military Medical Complex, Dhahran, Saudi Arabia.
Int J Clin Pharm. 2018 Dec;40(6):1601-1613. doi: 10.1007/s11096-018-0737-2. Epub 2018 Oct 26.
Background Transition of care on admission to the hospital and between clinical areas are risk points for medication errors. All type of medication errors can be reduced by improving communication at each transition point of care. Objectives This study examines the impact of pharmacist obtained best possible medication histories on medication errors at admission due to unintentional medication discrepancies in older patients. Setting This was a prospective, single-center study conducted in an Internal Medicine Department of a tertiary care teaching hospital in Saudi Arabia. Methods Patients ≥ 65 years with an existing drug therapy on admission were eligible. The best possible medication history taken by the pharmacist from different sources of medication information was compared to the admission medication order to identify and correct unintentional discrepancies. The discrepancies were classified according to the type of errors. An independent multidisciplinary team adjudicated the potential for harm of each type of medication error. Main outcome measure Number and proportion of unintentional medication discrepancies upon admission and associated medication errors. Secondary outcomes included clinical significance and drug classes involved in the discrepancies and risk factors for the occurrence of these discrepancies. Results A total of 375 evaluable patients were identified. Among 375 medication histories, 609 discrepancies were detected of which 226 were recorded as unintentional. 151 patients (42.4%) had ≥ 1 unintended discrepancy. Drug omission (37%) was the most frequent type of error. Nervous system (24.5%), and cardiovascular system (21.2%) were the most common drug classes involved in medication errors. Three-fifths of the UMD had the potential to cause temporary harm with initial or prolonged hospitalization. The number of medications prescribed upon admission (OR 1.32, 95% CI 1.09-1.54, p < 0.034), number of sources consulted for the best possible medication history (OR 1.53, 95% CI 1.38-1.76, p < 0.01) and the completion of medication review process within 24 h (OR 0.89, 95% CI 0.86-0.94, p < 0.03) of the admission were the 3 most significant predictors of the discrepancies. Conclusions In elderly patients, medication histories are often recorded inaccurately by physicians at the time of hospital admission, this creates the potential for medication errors starting at admission. In older adults, best possible medication histories are also useful in detecting drug related pathology or drug-drug interactions.
患者入院时以及在不同临床科室之间的护理转接是用药错误的风险点。通过改善每个护理转接点的沟通，可以减少所有类型的用药错误。目的：本研究探讨药师获取的最佳用药史对老年患者入院时因无意用药差异导致的用药错误的影响。背景：这是一项在沙特阿拉伯一家三级护理教学医院的内科进行的前瞻性单中心研究。方法：纳入入院时已有药物治疗的65岁及以上患者。将药师从不同用药信息来源获取的最佳用药史与入院用药医嘱进行比较，以识别和纠正无意的差异。根据错误类型对差异进行分类。一个独立的多学科团队对每种用药错误的潜在危害进行判定。主要结局指标：入院时无意用药差异的数量和比例以及相关用药错误。次要结局包括差异的临床意义、涉及差异的药物类别以及这些差异发生的风险因素。结果：共确定了375例可评估患者。在375份用药史中，检测到609处差异，其中226处被记录为无意的。151例患者（42.4%）存在≥1处无意差异。漏服药物（37%）是最常见的错误类型。神经系统药物（24.5%）和心血管系统药物（21.2%）是用药错误中最常涉及的药物类别。五分之三的无意用药差异有可能在初次或长期住院期间造成暂时伤害。入院时开具的药物数量（OR 1.32，95%CI 1.09 - 1.54，p < 0.034）、获取最佳用药史时咨询的信息来源数量（OR 1.53，95%CI 1.38 - 1.76，p < 0.01）以及入院后24小时内完成用药审查过程（OR 0.89，95%CI 0.86 - 0.94，p < 0.03）是差异的3个最显著预测因素。结论：在老年患者中，医生在入院时往往不能准确记录用药史，这在入院时就造成了用药错误的可能性。对于老年人，最佳用药史也有助于检测与药物相关的病理情况或药物相互作用。
