Emergency Department, AULSS 2, Via C. Forlanini 71, 31029, Vittorio Veneto, Treviso, Italy.
Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Loredan 18, Padova, Italy.
Int J Clin Pharm. 2020 Aug;42(4):1061-1072. doi: 10.1007/s11096-020-01077-2. Epub 2020 Jun 17.
Background Medication errors at different transitions of care are common and potentially harmful. Medication reconciliation process should be evaluated to reduce the unintentional discrepancies. Objective This study aims to identify and classify unintentional medication discrepancies at hospital admission and discharge and associated risk factors. Setting Two general internal medicine and a pulmonology wards of an Italian non-academic hospital. Method A retrospective observational study was conducted among adult patients admitted to the wards. In order to evaluate the current medication reconciliation process of these wards, the frequency and type of unintentional chronic medication discrepancies between the physician assessment of home medication and hospital admission and discharge prescriptions were studied. Patients' characteristic associated with the presence of at least one unintentional discrepancy were evaluated. Main outcome measure Frequencies of unintentional medication discrepancies upon admission and discharge and associated patients' characteristics. Results Among the 144 patients enrolled in the study, 53 and 64 unintentional medication discrepancies were identified at hospital admission and at discharge, respectively. Both at admission and discharge a quarter of patients had at least one unintentional discrepancy. 'Medication omission' was the most frequent type of discrepancy identified and respiratory system and nervous system were the classes of medication with the highest rate of unintentional discrepancies. Unintentional discrepancies were more likely to occur in patients receiving more medicine pre-admission, longer hospitalization stays and coming from or discharged to a nursing home. Conclusion Transitions of care are critical moments for patient safety in terms of unintentional medication discrepancies and a more structured medication reconciliation process is needed. The medication reconciliation process should be considered in terms of a multidisciplinary approach involving all health professionals as well as patients and caregivers directly.
在不同的医疗护理转衔过程中，用药错误较为常见，且可能具有潜在危害。应当对用药核对流程进行评估，以减少非故意的差异。
本研究旨在识别和分类入院和出院时的非故意用药差异，并确定其相关风险因素。
意大利一家非学术性医院的两个普通内科病房和一个呼吸内科病房。
这是一项在病房住院患者中进行的回顾性观察性研究。为了评估这些病房当前的用药核对流程，研究了医生对家庭用药评估与入院和出院处方之间的慢性用药差异的频率和类型。评估了与存在至少一处非故意差异相关的患者特征。
入院和出院时非故意用药差异的发生频率以及相关的患者特征。
在纳入研究的 144 名患者中，分别有 53 处和 64 处入院和出院时的非故意用药差异。入院和出院时，各有四分之一的患者存在至少一处非故意差异。“用药遗漏”是最常见的差异类型，而呼吸系统和神经系统类药物的非故意差异发生率最高。在入院前接受更多药物治疗、住院时间较长以及来自或转至疗养院的患者，更有可能出现非故意差异。
就非故意用药差异而言，医疗护理转衔是患者安全的关键时刻，需要更具结构化的用药核对流程。应考虑从多学科角度出发，让所有卫生保健专业人员以及患者及其护理人员直接参与用药核对流程。
