Pharmacy, CHU Reims, Reims, France
Pharmacy, CHU Reims, Reims, France.
Eur J Hosp Pharm. 2022 Sep;29(5):264-270. doi: 10.1136/ejhpharm-2020-002283. Epub 2020 Dec 8.
Medication reconciliation (MR) is recognised as an important tool in preventing medication errors such as unintentional discrepancies (UDs). The aim of this study was to identify independent predictive factors of UDs during MR at patient admission to an orthopaedic and trauma department. The secondary objective was to build and validate a ready-to-use score to prioritise patients.
A retrospective study was performed on 3.5 years of pharmacist-led MR in the orthopaedic and trauma department of a large university teaching hospital. Independent predictors of UD were identified by multivariable logistic regression. A priority score to identify patients at risk of at least one UD was constructed from the odds ratios of the risk factors, and validated in a separate cohort. Performance was assessed with sensitivity, specificity, C-statistic and Hosmer-Lemeshow goodness-of-fit.
In total, 888 patients were included and 387 UDs were identified, mainly drug omissions (65.1%). Five independent predictors of UD were identified: age >75 years (OR 2.05, 95% CI 1.41 to 3.00; p<0.001), admission during school holidays (OR 1.69, 95% CI 1.17 to 2.44; p=0.005), female gender (OR 2.20, 95% CI 1.53 to 3.16; p<0.001), emergency hospitalisation (OR 2.05, 95% CI 1.45 to 2.92; p<0.001), and ≥5 medications on the best possible medication history (BPMH) (OR 3.29, 95% CI 2.20 to 4.94; p<0.001). Based on these predictors, a priority score ranging from 0 to 10 was built and internally and externally validated (C statistic 0.72, 95% CI 0.67 to 0.76).
This study confirms the high prevalence of UD in patients admitted to orthopaedic and trauma surgery departments. Five independent predictive factors of UD during MR were identified (female gender, emergency hospitalisation, hospitalisation during school holidays, age ≥75 years, and ≥5 medicines on the BPMH). The developed risk score will help to prioritise MR among patients at risk of medication error and is ready-to-use in other orthopaedic and trauma departments.
药物重整（MR）被认为是预防药物错误（如非故意差异[UD]）的重要工具。本研究的目的是确定在骨科和创伤科患者入院时进行 MR 期间发生 UD 的独立预测因素。次要目的是构建和验证一个用于确定患者优先级的现成评分。
对一家大型大学教学医院的骨科和创伤科进行的为期 3.5 年的药师主导的 MR 进行回顾性研究。通过多变量逻辑回归确定 UD 的独立预测因素。从危险因素的优势比构建了一个用于识别至少有一个 UD 风险患者的优先级评分，并在单独的队列中进行验证。使用灵敏度、特异性、C 统计量和 Hosmer-Lemeshow 拟合优度评估性能。
共纳入 888 例患者，共发现 387 例 UD，主要为药物漏用（65.1%）。确定了 UD 的五个独立预测因素：年龄＞75 岁（OR 2.05，95%CI 1.41 至 3.00；p＜0.001）、在学校假期期间入院（OR 1.69，95%CI 1.17 至 2.44；p=0.005）、女性（OR 2.20，95%CI 1.53 至 3.16；p＜0.001）、紧急入院（OR 2.05，95%CI 1.45 至 2.92；p＜0.001）以及最佳可能用药史（BPMH）上有≥5 种药物（OR 3.29，95%CI 2.20 至 4.94；p＜0.001）。基于这些预测因素，构建了一个范围为 0 至 10 的优先级评分，并进行了内部和外部验证（C 统计量为 0.72，95%CI 0.67 至 0.76）。
本研究证实了骨科和创伤外科患者入院时 UD 的高发生率。确定了 MR 期间发生 UD 的五个独立预测因素（女性、紧急入院、学校假期住院、年龄≥75 岁、BPMH 上有≥5 种药物）。开发的风险评分将有助于确定有药物错误风险的患者的 MR 优先级，并且可以在其他骨科和创伤外科部门中使用。
