Potential Risk of Medication Discrepancies and Reconciliation Errors at Admission and Discharge from an Inpatient Medical Service
Potential Risk of Medication Discrepancies and Reconciliation Errors at Admission and Discharge from an Inpatient Medical Service
复制标题
DOI：
10.1345/aph.1p184
复制
发表时间：
2010-11-01
影响因子：
2.9
通讯作者：
Jimenez-Torres, N. Victor
中科院分区：
文献类型：
--
作者：
Climente-Marti, Monica;Garcia-Manon, Elda R.;Jimenez-Torres, N. Victor
背景：用药差异，定义为治疗过渡期间药物方案之间无法解释的变化，是常见的。有些是无意的，并导致和解错误，这是潜在的patients.Objective：确定住院患者的入院和出院时的用药差异和和解错误的患病率，并探讨和解错误的风险因素及其潜在的临床impacts.METHODS：一项观察性前瞻性研究进行了综合教学医院。研究纳入了住院接受内科服务并接受长期入院前治疗的患者。将入院前治疗与入院（前48小时）和出院时处方的治疗进行比较，并确定差异和核对错误。主要终点是入院和/或出院时存在核对错误。潜在的风险因素（患者，药物，和系统相关的）和解错误进行了分析，使用多变量logistic回归model.Results：在2009年4月至8月的研究中，109（90.8%）的120例患者中，显示513差异。发生核对错误的患者患病率为20.8%（95% CI 13.6 - 28.1）。预期用药差异在入院时（96.6%）比出院时（75.5%）更常见，而核对错误在出院时（24.5%）比入院时（3.4%）更常见。差异的患病率比（入院vs出院）为2.4（95%CI 1.9 - 3.0），核对错误的患病率比为0.65（95%CI 0.32 - 1.32）。Logistic回归分析显示，入院时的差异数（OR 1.21; 95%CI 1.01至1.44）和年龄（OR 1.05; 95%CI 0.99至1.10）之间存在关联，并且和解错误的风险增加。由于入院时的用药差异可能使患者易于发生核对错误，因此及早发现此类差异在逻辑上会降低核对错误的风险。药物协调计划必须实施一个收集准确的入院前药物历史的过程，并必须将此信息提交给对患者需求的关键评估。
BACKGROUND: Medication discrepancies, defined as unexplained variations among drug regimens at care transitions, are common. Some are unintended and cause reconciliation errors that are potentially detrimental for patients.OBJECTIVE: To determine the prevalence of medication discrepancies and reconciliation errors at admission and discharge in hospitalized patients and explore risk factors for reconciliation errors and their potential clinical impact.METHODS: An observational prospective study was conducted at a general teaching hospital. Patients who were admitted to the internal medicine service and were receiving chronic preadmission treatment were included in the study. Preadmission treatment was compared with the treatment prescribed on admission (first 48 hours) and at hospital discharge, and discrepancies and reconciliation errors were identified. The primary endpoint was the presence of reconciliation errors at admission and/or discharge. Potential risk factors (patient-, medication-, and system-related) for reconciliation errors were analyzed using a multivariate logistic regression model.RESULTS: Of the 120 patients enrolled in the study between April and August 2009, 109 (90.8%) showed 513 discrepancies. The prevalence of patients with reconciliation errors was 20.8% (95% CI 13.6 to 28.1). Intended medication discrepancies were more frequent at admission (96.6%) than at discharge (75.5%), while reconciliation errors were more frequent at discharge (24.5%) than at admission (3.4%). The prevalence ratio (admission vs discharge) was 2.4 (95% CI 1.9 to 3.0) for discrepancies and 0.65 (95% CI 0.32 to 1.32) for reconciliation errors. The logistic regression analysis revealed an association between the number of discrepancies at admission (OR 1.21; 95% CI 1.01 to 1.44) and age (OR 1.05; 95% CI 0.99 to 1.10) and an increased risk of reconciliation errors.CONCLUSIONS: Medication reconciliation strategies should focus primarily on avoiding errors at discharge. Since medication discrepancies at admission may predispose patients to reconciliation errors, early detection of such discrepancies would logically reduce the risk of reconciliation errors. Medication reconciliation programs must implement a process for gathering accurate preadmission drug histories and must submit this information to a critical assessment of patients' needs.