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Braz. J. Pharm. Sci. (Online) ; 58: e18587, 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1374541


Abstract Medication errors (ME) are frequent in the admission of patients to the ICU and can be identified and prevented through medication reconciliation (MR). Our aim was to evaluate the incidence, type and severity of MEs and associated factors, identified during MR in the ICU. This is a prospective, analytical approach, performed in the ICU of a private hospital, where the MRs were evaluated from April to June 2016. The SPSS and Stata programs were used to analyse the data. Logistic regression was performed to determine the factors associated with MEs. MR was performed with 136 patients, of whom 126 (92.6%) used drugs regularly. The incidence of MEs was 16.3% (95% CI 11.5-21.2). The main classes of drugs involved were those acting on the nervous and cardiovascular systems. There were 128 pharmaceutical interventions (acceptance: 71.1%). Regarding severity, 65.5% (n=80) of the errors reached the patient, but there was no harm. The risk factors for MEs identified were: age ≥60 years, number of comorbidities >1 and previous use of drugs ≥9. The incidence of MEs found and the significant association with age, comorbidities and polymedication alert to the need for specific attention to prevent admission errors in the most susceptible patient groups.

Braz. J. Pharm. Sci. (Online) ; 58: e19832, 2022. tab, graf
Article in English | LILACS | ID: biblio-1394063


Abstract Medication reconciliation is a strategy to minimize medication errors at the transition points of care. This study aimed to demonstrate the effectiveness of medication reconciliation in identifying and resolving drug discrepancies in the admission of adult patients to a university hospital. The study was carried out in a 300-bed large general public hospital, in which a reconciled list was created between drugs prescribed at admission and those used at pre-admission, adapting prescriptions from the pharmacotherapeutic guidelines of the hospital studied and the patients' clinical conditions. One hundred seven patients were included, of which 67,3% were women, with a mean age of 56 years. Two hundred twenty-nine discrepancies were found in 92 patients; of these, 21.4% were unintentional in 31.8% of patients. The pharmacist performed 49 interventions, and 47 were accepted. Medication omission was the highest occurrence (63.2%), followed by a different dose (24.5%). Thirteen (26.5%) of the 49 unintentional discrepancies included high-alert medications according to ISMP Brazil classification. Medication reconciliation emerges as an important opportunity for the review of pharmacotherapy at transition points of care, based on the high number of unintentional discrepancies identified and resolved. During the drug reconciliation process, the interventions prevented the drugs from being misused or omitted during the patient's hospitalization and possibly after discharge.

Humans , Male , Female , Middle Aged , Patients/classification , Medication Reconciliation/methods , Hospitals, University/classification , Pharmacists/ethics , Pharmaceutical Preparations/administration & dosage , Drug Therapy/instrumentation , Prescriptions/standards , Patient Safety , Medication Errors/adverse effects
China Pharmacy ; (12): 1263-1268, 2022.
Article in Chinese | WPRIM | ID: wpr-924082


OBJECTIVE To analyze the medication reconciliation for the inpatients in cardiovascular medicine department ,to provide reference for the establishment of working mode of clinical pharmacists in the department of cardiovascular medicine and to provide a basis for clinical pharmacists and community pharmacists developing pharmaceutical care for patients after transfering to community health center. METHODS From October 2020 to September 2021,newly admitted or newly transferred inpatients with chronic disease were selected from Shiyan People ’s Hospital of Shenzhen Bao ’an District. Medication reconciliation was conducted by clinical pharmacists after pharmaceutical consultation. According to the Pharmaceutical Care Network Europe (PCNE) classification system V 9.1,the existing drug-related problems (DRPs)were classified and summarized. The effectiveness and safety evaluation,medication education and other measures were provided ,and the acceptance of intervention was analyzed at the same time. RESULTS A total of 100 patients were included ,including 54 males and 46 females. The average age was (60.21±9.69) years,the average number of chronic diseases was (2.84±0.83),and the median number of drugs was 5.00. Among them ,110 treatment drug deviations were found in 74 patients,involving 10 categories and 61 drugs. Top three drugs in the list of accumulative drug deviation were cardiovascular system drugs (35 deviations),digestive medicine drugs (16 deviations)and endocrine system drugs (15 deviations). The above treatment drug deviation may cause 122 DRPs, mainly “treatment effectiveness”problems(74 DRPs),and the causes were “inappropriate medication time ormedication interval ”(32 DRPs), followed by “inappropriate drug combination ”(10 DRPs). Interventions to DRPs mainly concentrated on patient level ,drug level (58)and doctor level (58),155 of which (84.70%)were fully accepted and implemented. CONCLUSIONS Some patients have a weak awareness of medications according to doctor ’s advice;drug reconciliation led by clinical pharma- cists at admission can fully understand the potential drug problems of patients ,and help doctors improve the drug compliance of patients and ensure their medication safety .

Braz. J. Pharm. Sci. (Online) ; 57: e18064, 2021. tab, graf
Article in English | LILACS | ID: biblio-1339301


Medication discrepancies are of great concern in hospitals because they pose risks to patients and increase health care costs. The aim of this study was to estimate the prevalence of inconsistent medication prescriptions to adult patients admitted to a hospital in southern Santa Catarina, Brazil. This was a patient safety study on patients recruited between November 2015 and June 2016. The participants were interviewed and had their medical records reviewed. Discrepant medications were considered those that did not match between the list of medicines taken at home and the prescribed drugs for treatment in a hospital setting. Of the 394 patients included, 98.5% took continuous-use medications at home, with an average of 5.5 medications per patient. Discrepancies totaled 80.2%, The independent variables associated with the discrepancies were systemic arterial hypertension, hypercholesterolemia, vascular disease, number of medications taken at home, and poor documentation of the medications in the medical record. Findings from this study allowed us to conclude there was a high rate of prescription medication misuse. Medication reconciliation is crucial in reducing these errors. Pharmacists can help reduce these medication-related errors and the associated risks and complications.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Pharmacists/ethics , Drug Prescriptions/standards , Health Care Costs , Medication Reconciliation/ethics , Medication Errors/adverse effects , Patients/classification , Pharmaceutical Preparations , Medical Records/statistics & numerical data , Patient Safety , Drug Misuse/statistics & numerical data , Hospitals/supply & distribution
Int J Pharm Pharm Sci ; 2020 Jan; 12(1): 6-10
Article | IMSEAR | ID: sea-206042


Objective: To study the effects of medication reconciliation and patient counseling on the overall health benefits of the patients in the department of gastroenterology. Methods: This study is a prospective interventional study, was conducted in a 500 bedded MNR Hospital. The sample size taken was 150 patients and the study population comprised of patients aged 18-80 y, admitted in the hospital during the study period of six months. Results: Out of 150 patients, there were 98 (65.33%) male patients and 52 (34.67%) female patients. Patients between 18 and 30 y of age were 29(19.33%), between the age of 30 and 50 y were 71 (47.33%) and above 50 were 50(33.33%). Pancreatitis was most prevalent with 21% of total prevalence, followed by CLD and cholelithiasis with 17%, then IBD 16%, PUD and Gastritis 5%, GERD 4% and other diseases 15%. Conclusion: The basic role of the pharmacist, is to help in minimizing the errors and to perform medication reconciliation. In patient counseling, pharmacists provide information about the disease, and the medications to increase patient safety and the changes in the behavior for the better outcome.

Chinese Pharmaceutical Journal ; (24): 408-412, 2020.
Article in Chinese | WPRIM | ID: wpr-857772


OBJECTIVE: To develop the model of medication reconciliation (MR) service provided by clinical pharmacist for chronic kidney disease (CKD). METHODS: The definition, working process, development of MR were analyzed and the medication problems we reviewed were classified and intervened according to the newest Pharmaceutical Care Network Europe (PCNE) V9.0 classification scheme which was constructed for drug related problems (DRPs) to analysis and summary. We stated and summarized procedure of MR by several cases based on the realities of our hospital. RESULTS: A new closed loop model of outpatient clinic to hospital, then to home was developed, a working process was made according to three settings consist of outpatient clinic, hospital and home. CONCLUSION: The procedure of MR of several cases was summarized based on the realities on our hospital.

Saúde debate ; 43(121): 368-377, Apr.-June 2019. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1014615


RESUMO Este estudo avaliou a implantação da reconciliação de medicamentos em um hospital multibloco, filantrópico e de ensino com a utilização de um sistema eletrônico para realizar o registro da atividade com atuação multiprofissional. Foram capacitados 438 profissionais da enfermagem sobre a reconciliação de medicamentos. De outubro de 2017 a março de 2018, foram registradas pelo enfermeiro, no prontuário eletrônico, a informação sobre uso prévio de medicamentos para 1.379 pacientes. Foram reconciliados pelo farmacêutico apenas 347 destes registros, sendo que 106 precisaram de intervenção com médico prescritor. O número de pacientes que tiveram o medicamento informado como de uso prévio prescrito sem nenhuma alteração foi de 180, os que tiveram o medicamento prescrito com alguma alteração foram 47, e os que não possuíam os medicamentos informados prescritos foram 106. A utilização de sistemas informatizados pode ser útil para as equipes executarem a reconciliação medicamentosa, mas depende da correta utilização do sistema e treinamento das equipes. O acompanhamento diário do farmacêutico clínico aumenta a segurança do paciente quanto ao uso de medicamentos dentro dos hospitais, entretanto, para executar a atividade, é necessário realizar algumas medidas de melhoria para obter o cumprimento da reconciliação de medicamentos dos pacientes na sua totalidade.

ABSTRACT This study evaluated the implementation of medication reconciliation in a philanthropic, teaching, and multi-block hospital with the use of an electronic system to record the multidisciplinary activity. A total of 438 nursing professionals were trained on medication reconciliation. From October 2017 to March 2018, the information about previous use of drugs for 1,379 patients was registered by the nurse in the electronic system. Only 347 of those records were reconciled by the pharmacist, and 106 needed intervention of the prescribing doctor. The number of patients who had the medication prescribed without any change was 180, 47 had the medication prescribed with some change, and 106 did not have the prescribed the medications of previous use. The use of computerized systems can be useful for the teams to perform medication reconciliation, but it depends on the correct use of the system and training of the teams. The daily follow-up of the clinical pharmacist increases patient safety regarding the use of drugs within the hospitals, but to perform the activity some improvement measures are necessary to obtain compliance with the patients' medication reconciliation in their entirety.

Humans , Electronic Health Records , Medication Reconciliation , Patient Safety , Medication Errors , Pharmacy Service, Hospital , Medical Records Systems, Computerized , Drug Therapy , Drug Utilization
China Pharmacy ; (12): 110-114, 2019.
Article in Chinese | WPRIM | ID: wpr-816760


OBJECTIVE: To investigate and evaluate perioperative medication in elective surgery elderly patients, and to provide reference for perioperative medication management of clinical pharmacists for elderly patients. METHODS: Totally 210 elective surgery elderly patients were selected from Beijing Tsinghua Chang Gung Hospital during Oct. 2015 to Oct. 2016. Pharmacists carried out drug reconstitution, obtained information about their diseases and medication, analyzed and evaluated perioperative medication (indication, usage and dosage, interaction, drug selection, if these drugs should be stopped before surgery) according to Optimal Guidelines for Preoperative Evaluation of Elderly Patients so as to put forward related medication suggestions. RESULTS: Among 210 patients, there were 132 males (62.86%) and 78 females (37.14%) with an average age of (69.96±7.67) years; 43.81% of patients had more than 3 kinds of diseases, and 13.33% of patients suffered from more than 5 kinds of diseases; 31.43% of patients took more than 5 kinds of drug for long term before surgery; 38.10% patients had more than 2 drug-induced risks; The preoperative medication of 110 patients (52.38%) included drugs that should be avoided before surgery (such as antiplatelet aggregation agents), 23 patients (10.95%) had potentially inappropriate medication (such as proton pump inhibitors), 12 patients (5.71%) should use drugs (such as aspirin) cautiously, 35 patients (16.67%) should use drugs (β receptor blocker) continuously during perioperative period. The pharmacists provided 177 times of medication suggestions such as stopping some medications for patients and physicians through medication reconciliation and preoperative medication evaluation (71 times for patients, 106 times for physicians); the final adoption rates were 100% and 95.28%, respectively. CONCLUSIONS: The elderly patients have many preoperative complications, various risk factors, multiple medications, so it is vital for their preoperative medication management. The medication reconciliation is an effective way to evaluate preoperative medication in elderly patients, preoperative medication evaluation and analysis in elderly patients is of great significance to ensure the safety of clinical medication.

China Pharmacy ; (12): 268-271, 2019.
Article in Chinese | WPRIM | ID: wpr-816735


OBJECTIVE: To analyze the reliability and validity of Chinese version of MMAS-8 in evaluating the medication compliance of patients with chronic cardiovascular diseases, and to evaluate the effects of medication reconciliation on medication compliance. METHODS: Totally 97 patients with chronic cardiovascular diseases were selected as observation group. The reliability and validity of the questionnaire were analyzed and medication reconciliation was carried out. Totally 91 patients with chronic cardiovascular diseases were selected as control group, and given routine medical services. 8-item Morisk Medication Compliance Scale used to evaluate the drug compliance of the two groups at different time points. RESULTS: The F-test and t-test of the average score of 8 items in 27% of questionnaire score ranking head and tail of the two extreme groups had statistical significance (P<0.001). Correlation coefficient between the 8 items and the total scores was higher than 0.400, and the 8 items were significantly correlated with total scores (P<0.001). Internal consistency reliability coefficient was 0.763; the structure validity KMO value was 0.742; the Bartlett’s spherical test value was 266.007; factor analysis method was adopted to extract 2 common factors, and explained total variance was 58.907%. Compared with control group, medication compliance of observation group was improved significantly at the first week after discharge and one month after discharge (P<0.05). CONCLUSIONS: The Chinese version of MMAS-8 has good reliability and validity in evaluating drug compliance of patients with chronic cardiovascular disease; medication reconstitution service can improve medication compliance of patients.

Journal of Neurocritical Care ; (2): 110-118, 2018.
Article in Korean | WPRIM | ID: wpr-765910


BACKGROUND: The role of clinical pharmacists in medication therapy to improve clinical and economic outcomes has been reported in the literature. This study was conducted to analyze the changes in details of medication interventions before and after the introduction of clinical pharmacists into the care of neurocritical care unit (NCU) patients, and to evaluate the economic effects of clinical pharmacists by calculating the avoidance cost. METHODS: A retrospective study was conducted reviewing the electronic medical records from June 2013 to May 2014 (before), and from June 2016 to May 2017 (after). We calculated the number and rates of intervention, the acceptance rates of it, and also reviewed the list of interventions. We calculated avoidance cost if there was no intervention. RESULTS: The monthly mean number of interventions increased from 8.0 (±5.7) to 31.7 (±12.8) (P < 0.001) and the frequency of intervention also increased from 0.8% to 1.6% (P=0.003). The most frequently provided pharmacist intervention was nutritional support before introduction of clinical pharmacists and discussions on the medication plan after. The number of classified interventions was 14 before introduction of clinical pharmacist services and 33 after. The calculated cost avoidance associated with a clinical pharmacists' integration was 77,990,615 won per year. CONCLUSION: Introduction of clinicals pharmacist into the NCU was associated with increased intervention rates and expanded types of clinical interventions. The cost avoidance achieved by the pharmacists' interventions can be further explored to evaluate if similar expansions of pharmacists' services achieve similar results in other settings.

Costs and Cost Analysis , Electronic Health Records , Humans , Intensive Care Units , Medication Reconciliation , Nutritional Support , Pharmacists , Retrospective Studies
Chinese Pharmaceutical Journal ; (24): 2148-2151, 2018.
Article in Chinese | WPRIM | ID: wpr-858129


OBJECTIVE: To evaluate the efficacy of medication reconciliation (MR) service provided by clinical pharmacist for chronic kidney disease(CKD).METHODS: Patients with CKD administered in department of nephrology between Dec, 2017 and Mar. Total of 2018 who met the inclusion criteria were given MR service, and the newest Pharmaceutical Care Network Europe (PCNE) V8.02 classification scheme was constructed for drug related problems (DRP) to analysis and summary.RESULTS: MR was conducted 48 times (accounted for 80%) on 60 patients during the study period. Total of 59 medication DRP were identified. The most common DRP was treatment effectiveness (accounted for 84.75%), there were 54 causes (accounted for 76.06%) were prescribing in 71 causes, all the causes were classified as likely to cause level 1 harm (accounted for 84.75%), clinical pharmacists made 145 interventions, 102 (70.34%) of these were completely accepted and implement.CONCLUSION: DRPs are common in CKD patients, clinical pharmacists should provide MR for CKD patients, and conducted as routine work.

Clin. biomed. res ; 37(3): 181-186, 2017. tab, ilus, graf
Article in Portuguese | LILACS | ID: biblio-859777


Introdução: Discrepâncias nos registros eletrônicos de medicamentos são frequentes e podem levar a erros relacionados a medicamentos. O objetivo deste estudo foi analisar as discrepâncias entre os registros médicos e farmacêuticos da terapia medicamentosa de pacientes com fibrose cística de um ambulatório multidisciplinar de pneumologia infantil do Sul do Brasil Métodos: Estudo transversal com coleta de dados retrospectiva através de prontuário eletrônico de pacientes que foram atendidos no ambulatório de um centro de referência para Fibrose Cística entre maio e junho de 2016. Os registros médicos e farmacêuticos foram comparados e as discrepâncias quantificadas e classificadas. Resultados: Foram analisados 81 registros de consultas ambulatoriais de 76 pacientes. Oitenta medicamentos constavam nos registros, sendo os mais frequentes polivitamínicos, enzimas pancreáticas, dornase alfa, ácido ursodesoxicólico e solução salina hipertônica. Foram identificadas discrepâncias em 96% dos registros, totalizando 245 discrepâncias, entre elas omissões de medicamentos no registro farmacêutico (102) e no médico (80), além de doses (41) e regimes terapêuticos (23) diferentes. Foram observadas omissões de dose no registro farmacêutico (63) e no médico (52) e omissões de regime (11) em ambos. Conclusão: A elevada taxa de discrepâncias corrobora com os resultados de diversos estudos. A conciliação tem o objetivo de promover o uso racional e diminuir os erros relacionados a medicamentos, podendo ser realizada de maneira sistematizada. A avaliação da qualidade do uso de medicamentos pode ser feita através da utilização de indicadores, sendo as discrepâncias um indicador sensível para este objetivo (AU)

Introduction: Discrepancies in electronic records of medication are frequent and may lead to drug-related errors. This study aims to analyze discrepancies between medical and pharmaceutical records of pharmacotherapy in patients with cystic fibrosis in a multidisciplinary pediatric pulmonology outpatient hospital in southern Brazil. Methods: Transversal study with retrospective data collection through electronic medical records of patients assisted in the outpatient room of a reference center for cystic fibrosis within May and June 2016. Both records, medical and pharmaceutical, were compared and unconformities were quantified and classified. Results: An amount of 81 records of 76 patients were analyzed. A total of 80 medications were observed in the records, most frequently multivitamins, pancreatic enzymes, dornase alpha, ursodesoxycholic acid and hypertonic saline solution. The discrepancies were present in 96% of records, totaling 245 discrepancies, among them omissions of medication in the pharmaceutical records (102) and in the medical records (80), doses (41) and different therapy regimes (23). We observed omissions in pharmaceutical records (63), in medical records (52) and in both (11). Conclusion: The high level of discrepancies endorses results of a variety of studies. Reconciliation has the objective of promoting rational use and diminishing errors related to medication, when performed systematically. The evaluation of quality use of medication might be performed through the use of indicators, considering the discrepancy a sensible indicator for this goal (AU)

Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Cystic Fibrosis/drug therapy , Medical Records Systems, Computerized/statistics & numerical data , Medication Errors , Cross-Sectional Studies , Drug Prescriptions , Retrospective Studies
China Pharmacy ; (12): 4580-4584, 2017.
Article in Chinese | WPRIM | ID: wpr-704467


OBJECTIVE:To explore the importance and necessity of clinical pharmacists in drug therapy for chronic disease patients,the feasibility of developing medication reconciliation (MR),and to provide reference for establishing the internal medicine working model of clinical pharmacy.METHODS:During May to Jul.2016,inpatients were selected from respiratory department of our hospital as subjects.After detailed pharmaceutical consultation,clinical pharmacist conducted MR for newly inpatients at the first day in the hospital.RESULTS:Through clinical pharmacists classified and organized the problems of drug use in the inpatients during medication,MR records of 98 inpatients were collected,involving 296 medical orders and 96 items of medication errors.Among MR patients,there were only 44 cases of good compliance (44.9%);some problems about drug use existed in other cases,including optional medication,improper usage and dosage,fearing of drug side effects and refusing to use drugs,drug withdrawal due to ADR,follow-up failure of special disease leading to excessive or inadequate dose,poor communication with doctors leading to medication errors,forgetting to take medication or missing,excessive medical treatment and so on.Most common medication error-inducing drugs type was cardiovascular drug,followed by respiratory drug and endocrine system drug.CONCLUSIONS:The development of MR by clinical pharmacists is helpful to identify and correct medication error,avoid potential medication error,and control disease.It can be used as a project of pharmaceutical care in department of internal medicine.

China Pharmacy ; (12): 2002-2005, 2017.
Article in Chinese | WPRIM | ID: wpr-607935


OBJCETIVE:To investigate the role of clinical pharmacists in medication reconciliation. METHODS:Totally 200 inpatients admitted or transferred to nephrology department of our hospital during Aug.-Oct. 2015 were selected. Within 48 h after admission,1-year medication history were collected by reviewing electronic medical records,consultation,querying self-prepared drugs and medical history;and then medication reconciliation was conducted by clinical pharmacists. RESULTS:Among drug lists collected by clinical pharmacists,there were 987 kinds of drugs,but only 9.63%(95 kinds) drugs were recorded in the medical records. There were 5 cases of ADR in total,and only 40.00% of them (2 cases) were recorded in the medical records. Among 200 patients,medication reconciliation was needed in 45 cases with reconciliation rate of 22.50%. Among 492 medical orders of 200 patients,medication errors were found in 103 medical orders;the number of medication errors per case was (2.3 ± 1.8), mainly including wrong dose,repeated medication,wrong solvent,drug interactions;the potential risk degree was mainly degree 1 (53 orders,51.46%). Among 103 medication reconciliation orders,main plans were drug withdrawal (78 cases,75.73%), followed by drug change(17 cases,16.50%)and drug supplement(8 cases,7.77%). A total of 90 reconciled medical orders were adopted by physicians,with success rate of 87.38%. CONCLUSIONS:Compared with physicians,clinical pharmacists can obtain more detailed and accurate drug list. It can reduce medication error and guarantee the safety of drug use to maximum extent that clinical pharmacists conduct medication reconciliation.

China Pharmacist ; (12): 308-310, 2017.
Article in Chinese | WPRIM | ID: wpr-507571


Objective:To provide reference for clinical monitoring and treatment of patients with gastric ulcer caused by antiplate-let therapy. Methods: Clinical pharmacists participated in the pharmaceutical care of antiplatelet therapy for a patient with acute stroke, and provided pharmaceutical recommendations in respects of antiplatelet therapy, antihypertensive therapy and nursing care by means of medication reconciliation and medication education. Results: The stomach bleeding in the patient was controlled, and the blood pressure was controlled within the target value. Conclusion: Clinical pharmacist can ensure the medication safety and improve the medication compliance through monitoring drug use, which can further improve clinical effectiveness.

China Pharmacist ; (12): 305-308, 2017.
Article in Chinese | WPRIM | ID: wpr-507500


Objective:To discuss the important role of clinical pharmacists in the prevention of medication errors and rational drug use through medication reconciliation in endocrinology department. Methods: The medication reconciliation was given to the diabetic patients over 70 years old newly admitted in the endocrinology department from January to April 2016, and the consistency and appro-priateness of medication orders were verified and the results were collected and analyzed by the pharmacists. Results: Totally 84 pa-tients were enrolled into the research with the average age of (76. 3 ± 5. 0) and the average number of combined diseases of (3. 5 ± 1. 2). The average medications taken by the patients before the admission were (6. 7 ± 2. 9), and 22. 6% of the patients took tradi-tional Chinese medicines and 4. 76% of the patients took health products. The patients whose medications for 24h needed intervention accounted for 27. 38%, the medications orders needed intervention accounted for 3. 67%, and the intervention success rate of clinical pharmacist was 100%. Conclusion:To the patients over 70 years old with type 2 diabetes and multiple diseases treated with a variety of medications, medication reconciliation in 24 hours can effectively prevent the medication errors and promote the rational drug use.

Chinese Pharmaceutical Journal ; (24): 323-326, 2017.
Article in Chinese | WPRIM | ID: wpr-858814


OBJECTIVE: To clarify the importance of clinical pharmacists participating in the management of polypharmacy in comprehensive geriatric assessment. METHODS: The role of clinical pharmacists in the comprehensive geriatric assessment team was revealed through assessment of polypharmacy in one case of elderly outpatient's prescription. RESULTS: Clinical pharmacists successfully involved in the development of polypharmacy programs in the comprehensive geriatric assessment team. CONCLUSION: Comprehensive geriatric assessment can optimize the clinical treatment of elderly patients. Clinical pharmacist is an important member of the management of polypharmacy in the comprehensive geriatric assessment team. Hope that more clinical pharmacists to participate in this work, to provide quality pharmaceutical care for elderly patients.

Med. infant ; 23(1): 24-31, Marzo 2016. tab, ilus
Article in Spanish | LILACS | ID: biblio-881829


Introducción: La Conciliación Farmacoterapéutica garantiza el tratamiento medicamentoso correcto (dosis, vía y frecuencia) en relación a la situación actual del paciente. Objetivos: Determinar el grado de seguridad farmacoterapéutica en todas las transiciones del cuidado del paciente. Métodos: estudio descriptivo, transversal. Se realizó conciliación en las primeras 24 hs del ingreso en CIM (salas de internación de cuidados intermedios o moderados), Emergencia o UCI. Se incluyeron pacientes crónicos, que recibían más de 4 medicamentos, con readmisiones frecuentes y/o fármacos de bajo índice terapéutico. Se entrevistó a los pacientes/cuidadores, con previa firma del consentimiento informado y se recolectaron datos de la HCE para comparar el "mejor listado de medicación" obtenido con la indicación médica actual para analizar las discrepancias encontradas y resolverlas. Resultados: Se conciliaron en total 320 pacientes, encontrándose 1343 discrepancias totales, de las cuales 220 (16%) fueron errores de medicación. Se conciliaron 105 pacientes en la etapa emergencia (donde hubo más errores) 101 en la etapa CIM y 92 en la etapa UCI. El 42% de los pacientes sufrió al menos 1 error de medicación (omisión de indicación, el más frecuente). La mayoría de los errores no llegaron al paciente, esto fue evitado en el 52% por el padre y en el 39% por el farmacéutico. El 7% de los errores que llegaron al paciente causaron daños. En la conciliación al alta se halló que no se asienta en la HC la farmacoterapia de base. Conclusiones: La magnitud de los errores hallados es considerable, por lo que debería implementarse en forma rutinaria un programa de conciliación terapéutica, con énfasis en Emergencia (AU)

Introduction: Medication reconciliation guarantees adequate drug treatment (dose, route, and frequency) according to the current state of the patient. Aims: To determine the degree of medication safety in all transitions of patient care. Methods: A descriptive cross-sectional study. Reconciliation was carried out in the first 24 hours after admission to the ward (intermediate or moderate care wards), emergency department, or ICU. Chronic patients receiving more than 4 different drugs, with frequent readmissions, and/or narrow therapeutic index medications were included. Patients/caregivers were interviewed after signing informed consent and data were collected from the medical chart to compare the "best list of medications" obtained with the current medical indications to analyze discrepancies and resolve them. Results: Overall, reconciliation was carried out in 320 patients and 1343 discrepancies were observed, of which 220 (16%) were found to be medication errors. Reconciliation was carried out in 105 patients at the emergency department (where most errors were made), in 101 on the wards, and in 92 in the ICU. In 42% of the patients at least one medication error was observed (being omission of the indication the most common). The majority of errors did not affect the patient; they were avoided by the parent in 52% and by the pharmacist in 39%. Seven percent of the errors that did affect the patient caused damage. At reconciliation at discharge we found that in the medical chart baseline pharmacotherapy was not recorded. Conclusions: The magnitude of errors found was considerable and therefore a program of medication reconciliation should be routinely implemented, with emphasis on the emergency department (AU)

Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Chronic Disease/drug therapy , Medication Errors , Medication Reconciliation , Patient Safety , Transitional Care , Treatment Adherence and Compliance
Braz. j. pharm. sci ; 52(1): 143-150, Jan.-Mar. 2016. tab
Article in English | LILACS | ID: lil-789090


ABSTRACT One of the current barriers proposed to avoid possible medication errors, and consequently harm to patients, is the medication reconciliation, a process in which drugs used by patients prior to hospitalization can be compared with those prescribed in the hospital. This study describes the results of a pharmacist based reconciliation conducted during six months in clinical units of a university hospital. Fourteen patients (23.33%) had some kind of problem related to medicine. The majority (80%) of medication errors were due to medication omission. Pharmaceutical interventions acceptance level was 90%. The results suggest that pharmacists based reconciliation can have a relevant role in preventing medication errors and adverse events. Moreover, the detailed interview, conducted by the pharmacist, is able to rescue important information regarding the use of drugs, allowing to avoid medications errors and patient injury.

RESUMO Uma das barreiras propostas para se evitar possíveis erros relacionados a medicamentos e, consequentemente, que danos acometam o paciente, é a reconciliação medicamentosa no ato da internação, processo no qual se comparam os medicamentos usados pelos pacientes previamente à internação com os prescritos no âmbito hospitalar. Este trabalho descreve os resultados de seis meses de um processo de reconciliação conduzido por farmacêutico em unidades clínicas de um hospital universitário. Quatorze pacientes (23.33%) tiveram algum tipo de problema relacionado ao uso de medicamentos. A maioria dos erros envolvendo medicamentos (80%) estava relacionada à omissão de medicamentos. As intervenções farmacêuticas tiveram 90% de aceitação pelos médicos. Os resultados sugerem que a atuação de farmacêuticos na reconciliação medicamentosa pode desempenhar papel relevante na prevenção de erros de medicamentos e eventos adversos. Além disso, a entrevista detalhada conduzida por um farmacêutico se mostrou capaz de resgatar informações importantes sobre o uso dos medicamentos, permitindo evitar erros e danos ao paciente.

Inappropriate Prescribing/adverse effects , Medication Reconciliation/methods , Pharmaceutical Preparations , Patients/classification , Pharmacists/classification
Rev. latinoam. enferm. (Online) ; 24: e2760, 2016. tab, graf
Article in English | LILACS, BDENF | ID: biblio-961010


ABSTRACT Objectives: this observational study aimed to describe the discrepancies identified during medication reconciliation on patient admission to cardiology units in a large hospital. Methods: the medication history of patients was collected within 48 hours after admission, and intentional and unintentional discrepancies were classified as omission, duplication, dose, frequency, timing, and route of drug administration. Results: most of the patients evaluated were women (58.0%) with a mean age of 59 years, and 75.5% of the patients had a Charlson comorbidity index score between 1 and 3. Of the 117 discrepancies found, 50.4% were unintentional. Of these, 61.0% involved omission, 18.6% involved dosage, 18.6% involved timing, and 1.7% involved the route of drug administration. Conclusion: this study revealed a high prevalence of discrepancies, most of which were related to omissions, and 50% were unintentional. These results reveal the number of drugs that are not reincorporated into the treatment of patients, which can have important clinical consequences.

RESUMO Objetivos: este estudo observacional teve como objetivo descrever discrepâncias encontradas na realização de conciliação medicamentosa de pacientes admitidos em unidades de cardiologia de um hospital de grande porte. Métodos: a história de medicação dos pacientes foi coletada dentro de 48h após a admissão, e as discrepâncias, identificadas como intencionais ou não intencionais, foram classificadas como de: omissão, duplicidade, dose, frequência, intervalo e via. Resultados: a maioria dos pacientes incluídos pertençia ao sexo feminino (58,0%), com idade média de 59 anos, e com índice de comorbidades de Charlson entre 1 e 3 (75,5% dos casos). Das 117 discrepâncias encontradas, 50,4% foram não intencionais. Dessas, 61,0% foram de omissão, 18,6% de dose, 18,6% de intervalo e 1,7% de via de administração. Conclusão: o estudo mostra a alta prevalência de discrepâncias, principalmente de omissão, sendo quase metade não intencionais. Esse dado remete ao número de medicamentos que não são reincorporados ao tratamento dos pacientes, podendo repercutir em consequências clínicas importantes.

RESUMEN Objetivos: este estudio observacional tuvo como objetivo describir discrepancias encontradas en la realización de la conciliación medicamentosa de pacientes admitidos en unidades de cardiología de un hospital de gran porte. Métodos: la historia de medicación de los pacientes fue recolectada dentro de 48h después de la admisión, y las discrepancias, identificadas como intencionales o no intencionales, fueron clasificadas como: omisión, duplicidad, dosis, frecuencia, intervalo y vía. Resultados: la mayoría de los pacientes incluidos pertenecía al sexo femenino (58,0%), con edad promedio de 59 años, y con índice de comorbilidad de Charlson entre 1 y 3 (75,5% de los casos). De las 117 discrepancias encontradas, 50,4% fueron no intencionales. De estas, 61,0% fueron de omisión, 18,6% de dosis, 18,6% de intervalo y 1,7% de vía de administración. Conclusión: el estudio muestra la alta prevalencia de discrepancias, principalmente de omisión, siendo casi mitad de ellas no intencionales. Ese dato nos indica el número de medicamentos que no son reincorporados al tratamiento de los pacientes, lo que puede repercutir en consecuencias clínicas importantes.

Humans , Male , Female , Middle Aged , Patient Admission , Medication Reconciliation/statistics & numerical data , Cross-Sectional Studies , Hospital Units