Ságiné Eva Polics, Romvári Zsófia, Dormán Katalin, Endrei Dóra
PharmD. Komló Health Centre Mining Aftercare and Night Sanatorium Health Centre Institutional Pharmacy, Komló, Hungary.
Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Medical Center, Pécs, Hungary.
Pharm Pract (Granada). 2022 Oct-Dec;20(4):2729. doi: 10.18549/PharmPract.2022.4.2729. Epub 2022 Nov 8.
Patient safety and adverse event analysis are of paramount importance in the management of patient medication, given the significant economic burden they place on a country's healthcare system. Medication errors fall into the category of preventable adverse drug therapy events and are therefore of key importance from a patient safety perspective. Our study aims to identify the types of medication errors associated with the medication dispensing process and to determine whether automated individual medication dispensing with pharmacist intervention significantly reduces medication errors, thereby increasing patient safety, compared to traditional, ward base medication dispensing (by a nurse).
A prospective, quantitative, double-blind point prevalence study was conducted in three inpatient internal medicine wards of Komló Hospital in February 2018 and 2020. We analyzed data from comparisons of prescribed and non-prescribed oral medications in 83 and 90 patients per year aged 18 years or older with different diagnoses treated for internal medicine on the same day and in the same ward. In the 2018 cohort, medication was traditionally dispensed by a ward nurse, while in the 2020 cohort, it used automated individual medication dispensing with pharmacist intervention. Transdermally administered, parenteral and patient-introduced preparations were excluded from our study.
We identified the most common types of errors associated with drug dispensing. The overall error rate in the 2020 cohort was significantly lower (0.9%) than in the 2018 cohort (18.1%) (p < 0.05). Medication errors were observed in 51% of patients in the 2018 cohort, i.e. 42 patients, of which 23 had multiple errors simultaneously. In contrast, in the 2020 cohort, a medication error occurred in 2%, i.e. 2 patients (p < 0.05). When evaluating the potential clinical consequences of medication errors, in the 2018 cohort, the proportion of potentially significant errors was 76.2% and potentially serious errors 21.4%, whereas in the 2020 cohort, only three medication errors were identified in the potentially significant category due to pharmacist intervention, which was significantly lower (p < 0.05). Polypharmacy was detected in 42.2% of patients in the first study and in 12.2% (p < 0.05) in the second study.
Automated individual medication dispensing with pharmacist intervention is a suitable method to increase the safety of hospital medication, reduce medication errors, and thus improve patient safety.
鉴于患者用药管理给国家医疗系统带来的巨大经济负担，患者安全和不良事件分析在患者用药管理中至关重要。用药错误属于可预防的药物治疗不良事件范畴，因此从患者安全角度来看至关重要。我们的研究旨在确定与药品调配过程相关的用药错误类型，并确定与传统的病房基础药品调配（由护士进行）相比，有药剂师干预的自动化个人药品调配是否能显著减少用药错误，从而提高患者安全性。
2018年2月和2020年在科姆洛医院的三个内科住院病房进行了一项前瞻性、定量、双盲的现患率研究。我们分析了每年在同一天、同一病房接受内科治疗的83名和90名18岁及以上不同诊断患者的处方口服药和非处方口服药的对比数据。在2018年的队列中，药品由病房护士传统方式调配，而在2020年的队列中，采用有药剂师干预的自动化个人药品调配。经皮给药、肠胃外给药和患者自带制剂被排除在我们的研究之外。
我们确定了与药品调配相关的最常见错误类型。2020年队列中的总体错误率（0.9%）显著低于2018年队列（18.1%）（p < 0.05）。2018年队列中有51%的患者（即42名患者）出现用药错误，其中23名患者同时存在多种错误。相比之下，2020年队列中，用药错误发生率为2%，即2名患者（p < 0.05）。在评估用药错误的潜在临床后果时，2018年队列中，潜在重大错误的比例为76.2%，潜在严重错误的比例为21.4%，而在2020年队列中，由于药剂师的干预，仅在潜在重大类别中发现了3例用药错误，这一比例显著更低（p < 0.05）。在第一项研究中，42.2%的患者存在多种药物治疗，在第二项研究中这一比例为12.2%（p < 0.05）。
有药剂师干预的自动化个人药品调配是提高医院用药安全性、减少用药错误从而改善患者安全的一种合适方法。
