Clinical Pharmacy Department, University Hospital, Montpellier, France.
Department of Internal Medicine and Hypertension, Montpellier University Hospital, Montpellier, France.
Int J Clin Pract. 2021 Feb;75(2):e13663. doi: 10.1111/ijcp.13663. Epub 2020 Dec 14.
Medication errors (ME) can be reduced through preventive strategies such as medication reconciliation. Such strategies are often limited by human resources and need targeting high risk patients.
To develop a score to identify patients at risk of ME detected during medication reconciliation in a specific population from internal medicine unit.
Prospective observational study conducted in an internal medicine unit of a French University Hospital from 2012 to 2016. Adult hospitalised patients were eligible for inclusion. Medication reconciliation was conducted by a pharmacist and consisted in comparing medication history with admission prescription to identify MEs. Risk factors of MEs were analysed using multivariate stepwise logistic regression model. A risk score was constructed using the split-sample approach. The split was done at random (using a fixed seed) to define a development data set (N = 1256) and a validation sample (N = 628). A regression coefficient-base scoring system was used adopting the beta-Sullivan approach (Sullivan's scoring).
Pharmacists detected 740 MEs in 368/1884 (19.5%) patients related to medication reconciliation. Female gender, number of treatments >7, admission from emergency department and during night or weekend were significantly associated with a higher risk of MEs. Risk score was constructed by attributing 1 or 2 points to these variables. Patients with a score ≥3 (OR [95% CI] 3.10 [1.15-8.37]) out of 5 (OR [95% CI] 8.11 [2.89-22.78]) were considered at high risk of MEs.
Risk factors identified in our study may help prioritising patients admitted in internal medicine units who may benefit the most from medication reconciliation (ClinicalTrials.gov number NCT03422484).
通过药物重整等预防策略可以减少用药错误（ME）。这些策略通常受到人力资源的限制，需要针对高风险患者。
为了在特定人群的内科病房中，开发一种评分系统，以识别药物重整过程中发现的 ME 高危患者。
这是一项在法国大学附属医院内科病房进行的前瞻性观察性研究，时间为 2012 年至 2016 年。纳入成年住院患者。药物重整由药剂师进行，包括比较用药史和入院处方，以确定 ME。采用多变量逐步逻辑回归模型分析 ME 的危险因素。采用分割样本法构建风险评分。随机分割（使用固定种子）定义开发数据集（N=1256）和验证样本（N=628）。采用基于回归系数的 Sullivan 评分法（Sullivan's scoring）构建评分系统。
在 1884 例患者中，药师在 368 例（19.5%）患者中发现 740 例 ME 与药物重整有关。女性、治疗药物数量>7、急诊入院和夜间或周末入院与 ME 风险增加显著相关。通过对这些变量分别赋予 1 或 2 分，构建风险评分。评分≥3 分（OR [95%CI] 3.10 [1.15-8.37]）的患者被认为 ME 风险高，评分≥5 分（OR [95%CI] 8.11 [2.89-22.78]）的患者风险更高。
本研究确定的危险因素可能有助于确定内科病房中需要优先进行药物重整的患者，这些患者可能从中获益最大（ClinicalTrials.gov 编号：NCT03422484）。
