Park Jiyoung, Kim A Jeong, Cho Eun-Jung, Cho Yoon Sook, Jun Kwanghee, Jung Yoon Sun, Lee Ju-Yeun
College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
Department of Pharmacy, Seoul National University Hospital, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
BMC Geriatr. 2024 Dec 18;24(1):1000. doi: 10.1186/s12877-024-05517-w.
Unintentional medication discrepancies during care transitions pose a significant risk for medication errors, particularly in critically ill older patients. This study aimed to investigate the prevalence of such discrepancies during care transitions and their impact on post-discharge emergency department (ED) visits in this patient population.
This retrospective cross-sectional study included patients aged 65 and older who were on chronic medications and admitted to the intensive care units of emergency departments (ED-ICUs) between 2019 and 2020. We evaluated unintentional medication discrepancies, including omissions or changes in medication type, dose, frequency, formulation, or administration route without clear clinical justification during care transition. The association between these discrepancies and post-discharge ED visits was analyzed using a multivariable Cox-proportional hazard model.
Of the 339 patients analyzed, 68% encountered unintentional medication discrepancies at some point during care transitions, with prevalence of 35% at admission, 20% during transfer, and 49% at discharge. After adjusting for confounding factors, patients with unintentional medication discrepancies had a twofold higher risk of ED visits within 30 days of discharge (HR = 2.13, 95% CI = 1.06-4.30).
This study demonstrated a substantial prevalence of unintentional medication discrepancies among critically ill older adults during care transitions, significantly increasing the risk of ED visits within a month of discharge. The findings highlight the crucial need for systematic identification and management of medication discrepancies throughout the care transition process to enhance patient safety.
护理转接过程中无意出现的用药差异会带来重大用药错误风险，尤其是在危重症老年患者中。本研究旨在调查该患者群体护理转接期间此类差异的发生率及其对出院后急诊科（ED）就诊的影响。
这项回顾性横断面研究纳入了2019年至2020年间年龄在65岁及以上、正在服用慢性药物且入住急诊科重症监护病房（ED-ICU）的患者。我们评估了无意用药差异，包括在护理转接期间无明确临床理由的用药遗漏或药物类型、剂量、频率、剂型或给药途径的改变。使用多变量Cox比例风险模型分析这些差异与出院后ED就诊之间的关联。
在分析的339例患者中，68%在护理转接的某个阶段出现了无意用药差异，入院时发生率为35%，转院期间为20%，出院时为49%。在调整混杂因素后，有无意用药差异的患者在出院后30天内ED就诊风险高出两倍（HR = 2.13，95% CI = 1.06 - 4.30）。
本研究表明，危重症老年患者在护理转接期间无意用药差异的发生率很高，显著增加了出院后一个月内ED就诊的风险。研究结果凸显了在整个护理转接过程中系统识别和管理用药差异以提高患者安全的迫切需求。
