ABSTRACT
Objetivos : el objetivo de este estudio fue determinar si la transición del alta de la unidad de cuidados intensivos a la planta de hospitalización conlleva un alto riesgo de errores de conciliación. Se definió como objetivo principal del estudio describir y cuantificar las discrepancias y los errores de conciliación. Los objetivos secundarios incluyeron clasificar los errores de conciliación por tipo, grupo terapéutico de los medicamentos implicados y la gravedad potencial. Métodos: se llevó a cabo un estudio observacional retrospectivo de los pacientes dados de alta de la unidad de cuidados intensivos a la planta de hospitalización. Antes de que un paciente fuese dado de alta desde la unidad de cuidados intensivos, sus últimas prescripciones fueron comparadas con el listado de medicación propuesto en la planta de hospitalización. Las discrepancias entre ambos listados fueron clasificadas como discrepancias justificadas o errores de conciliación. Los errores de conciliación fueron clasificados por tipo de error, por gravedad potencial y por grupo terapéutico. Resultados: fueron conciliados 452 pacientes. Se encontró al menos una discrepancia en un 34,29% (155/452), y presentaba al menos un error de conciliación 18,14% (82/452). Los errores de conciliación más frecuentes fueron diferente dosis o vía de administración (31,79% [48/151]) y errores de omisión (31,79% [48/151]). Un 19,20% (29/151) involucraba a medicamentos de alto riesgo. Conclusiones: el alta desde la unidad de cuidados intensivos a la planta de hospitalización convencional es una transición asistencial que presenta alto riesgo de errores de conciliación. Los errores de conciliación ocurren con frecuencia, en ocasiones involucran a medicamentos de alto riesgo, su potencial gravedad puede requerir una monitorización adicional o producir daño temporal, y en algunos casos, más de un error de conciliación puede tener lugar. ... (AU)
Objectives: The aim of this study was to determine whether the transition of care from the intensive care unit to the ward would pose a high risk for reconciliation errors. The primary outcome of this study was to describe and quantify the discrepancies and reconciliation errors. Secondary outcomes included classification of the reconciliation errors by type of medication error, therapeutic group of the drugs involved and grade of potential severity. Methods: We conducted a retrospective observational study of reconciliated adult patients discharged from the Intensive Care Unit to the ward. Before a patient was discharged from the intensive care unit, their last intensive care units prescriptions were compared with their proposed medication list in the ward. The discrepancies between these were classified as justified discrepancies or reconciliation errors. Reconciliation errors were classified by type of error, potential severity, and therapeutic group. Results: We found that 452 patients were reconciliated. At least one discrepancy was detected in 34.29% (155/452), and 18.14% (82/452) had at least one reconciliation errors. The most found error types were a different dose or administration route (31.79% [48/151]) and omission errors (31.79% [48/151]). High alert medication was involved in 19.20% of reconciliation errors (29/151). Conclusions: Our study shows that intensive care unit to non-intensive care unit transitions are high-risk processes for reconciliation error. They frequently occur and occasionally involve high alert medication, and their severity could require additional monitoring or cause temporary harm. Medication reconciliation can reduce reconciliation errors. (AU)
Subject(s)
Humans , Medication Reconciliation , Intensive Care Units , Inpatient Care Units , Medication Errors , Retrospective Studies , PharmacistsABSTRACT
OBJECTIVES: The aim of this study was to determine whether the transition of care from the intensive care unit to the ward would pose a high risk for reconciliation errors. The primary outcome of this study was to describe and quantify the discrepancies and reconciliation errors. Secondary outcomes included classification of the reconciliation errors by type of medication error, therapeutic group of the drugs involved and grade of potential severity. METHODS: We conducted a retrospective observational study of reconciliated adult patients discharged from the Intensive Care Unit to the ward. Before a patient was discharged from the intensive care unit, their last intensive care unit's prescriptions were compared with their proposed medication list in the ward. The discrepancies between these were classified as justified discrepancies or reconciliation errors. Reconciliation errors were classified by type of error, potential severity, and therapeutic group. RESULTS: We found that 452 patients were reconciliated. At least one discrepancy was detected in 34.29% (155/452), and 18.14% (82/452) had at least one reconciliation errors. The most found error types were a different dose or administration route (31.79% [48/151]) and omission errors (31.79% [48/151]). High alert medication was involved in 19.20% of reconciliation errors (29/151). CONCLUSIONS: Our study shows that intensive care unit to non-intensive care unit transitions are high-risk processes for reconciliation error. They frequently occur and occasionally involve high alert medication, and their severity could require additional monitoring or cause temporary harm. Medication reconciliation can reduce reconciliation errors.
Subject(s)
Medication Reconciliation , Patient Discharge , Adult , Humans , Medication Errors/prevention & control , Intensive Care Units , HospitalsABSTRACT
OBJECTIVES: The aim of this study was to determine whether the transition of care from the intensive care unit to the ward would pose a high risk for reconciliation errors. The primary outcome of this study was to describe and quantify the discrepancies and reconciliation errors. Secondary outcomes included classification of the reconciliation errors by type of medication error, therapeutic group of the drugs involved and grade of potential severity. METHODS: We conducted a retrospective observational study of reconciliated adult patients discharged from the Intensive Care Unit to the ward. Before a patient was discharged from the intensive care unit, their last intensive care unit's prescriptions were compared with their proposed medication list in the ward. The discrepancies between these were classified as justified discrepancies or reconciliation errors. Reconciliation errors were classified by type of error, potential severity, and therapeutic group. RESULTS: We found that 452 patients were reconciliated. At least one discrepancy was detected in 34.29% (155/452), and 18.14% (82/452) had at least one reconciliation errors. The most found error types were a different dose or administration route (31.79% (48/151)) and omission errors (31.79% (48/151)). High alert medication was involved in 19.20% of reconciliation errors (29/151). CONCLUSIONS: Our study shows that intensive care unit to non-intensive care unit transitions are high-risk processes for reconciliation error. They frequently occur and occasionally involve high alert medication, and their severity could require additional monitoring or cause temporary harm. Medication reconciliation can reduce reconciliation errors.
Subject(s)
Medication Reconciliation , Patient Discharge , Adult , Humans , Medication Errors/prevention & control , Intensive Care Units , HospitalsABSTRACT
Background Medication errors frequently occur during transitions of care and may have damaging consequences, especially amongst the elderly. Some studies show that quality improvement initiatives with a focus on medication reconciliation have resulted in better health outcomes and a reduced number of readmissions. Objective The primary objective of this study was to quantify and classify medication reconciliation errors detected by a pharmacist and taking place during transitions of care between nursing homes and the health system. Secondary objectives were to assess the relation between error frequency and polypharmacy or between error frequency and the transition type and to describe the medication concerned by this error. Setting Five elderly nursing homes of the health care area in Ferrol (Spain) between January 2013 and December 2017 Method A prospective descriptive study on medication discrepancies found during pharmacist's medication reconciliation. This was performed at first admission and after every transition of care upon the patient's return to the nursing home. Interventions were categorized according to the consensus terminology. Main outcome measure Number and type of medication errors, percentage of transitions of care and percentage of patients who suffered at least one reconciliation error were measured. Results At least one medication error was found in 16% of the 2123 studied care transitions, summing up 417 reconciliation errors in 273/981 patients (28%). Wrong dosing (48%) and medication omissions (31%) were the most frequently detected errors. High-risk medication was involved in 40% of the cases. A positive association between polypharmacy (≥ 5 chronic medications) and the frequency of reconciliation errors was found. On the other hand, different transition types did not show a difference in error frequency. Conclusion Reconciliation errors were found in almost 30% of our patients. Unlike other studies, visits to outpatient specialist clinics were included as another type of healthcare transition, encompassing an important percentage of reconciliation errors. The pharmacist helped to reduce these errors in a particularly fragile population such as institutionalized patients.
Subject(s)
Homes for the Aged/standards , Medication Reconciliation/standards , Nursing Homes/standards , Patient Admission/standards , Patient Safety/standards , Pharmacists/standards , Aged , Aged, 80 and over , Female , Humans , Male , Medication Reconciliation/methods , Spain/epidemiologySubject(s)
Dosage Forms/standards , Polypharmacy , Administration, Oral , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Institutionalization , MaleABSTRACT
OBJECTIVE: to analyze the impact of Pharmacy Intervention (PI), within the healthcare team who manages elderly multi-pathological patients, regarding the evolution of Drug Related Problems (DRPs) and Negative Outcomes Associated with Medication (NOMs). To estimate the prevalence of DRPs, NOMs, and Potentially Inappropriate Prescriptions (PIPs), and the drugs involved, considering the characteristics of their healthcare location. METHOD: multicenter, prospective study, on > 65-year-old patients with multiple pathologies, either institutionalized or hospitalized. The Pharmacist reviewed the chronic medication of the patient in order to detect DRPs and NOMs, and issued recommendations to the physician responsible for the patient, and this intervention was subsequently evaluated. DRPs and NOMs were classified according to the Third Consensus of Granada. The STOPP/START Criteria were used for PIP detection. The primary variables were: number of PIs conducted and accepted by the physician. OUTCOMES: 338 patients were included, and 326 (96.4%) presented some DRP. 1089 DRPs were detected, with 983 PIs suggested for their solution, and 651 (69.9%) of these were accepted. PIs solved 58.9% of DRPs, and an association was found between PI and the solution for the DRP (p < 0.001). PIs were more accepted in institutionalized than in hospitalized patients (p = 0.002), by physicians with a higher specialization (p < 0.001) and when they involved quantitative safety NOMs (p = 0.042). The STOPP/START Criteria detected 65% of PIPs, and more PIPs not associated with these criteria were found in institutionalized than in hospitalized patients (p < 0.001). CONCLUSIONS: pharmacy Intervention within the multidisciplinary team can solve in a significant way both DRPs and NOMs in elderly multi-pathological patients, and thus help to improve the quality of their pharmacological therapy. This is the first multicenter clinical trial with these characteristics that has been conducted in Spain.
Objetivo: analizar el impacto de la Intervención Farmacéutica (IF), dentro del equipo asistencial que atiende al paciente mayor pluripatológico, en la evolución de los Problemas Relacionados con la Medicación (PRM) y los Resultados Negativos asociados con la Medicación (RNM). Estimar la prevalencia de PRM, RMN y Prescripciones Potencialmente Inadecuadas (PPI), y fármacos implicados, considerando las características de su ubicación asistencial. Método: estudio multicéntrico, prospectivo, de intervención, en pacientes mayores de 65 años pluripatológicos, institucionalizados u hospitalizados. El farmacéutico revisó la medicación crónica del paciente para detectar PRM y RNM y emitió recomendaciones al médico responsable del paciente, valorando posteriormente el efecto de dicha intervención. Los PRM y los RNM se clasificaron según el Tercer Consenso de Granada. Para la detección de PPI se utilizaron los Criterios STOPP/START. Las variables principales fueron: número IF realizadas y aceptadas por el médico. Resultados: se incluyeron 338 pacientes, presentando 326 (96,4%) algún PRM. Se detectaron 1.089 PRM, proponiéndose para su resolución 933 IF y aceptándose 651(69,9%). Las IF resolvieron 58,9% de los PRM, encontrándose asociación entre la IF y la resolución del PRM (p < 0.001). Las IF fueron más aceptadas en pacientes institucionalizados que en hospitalizados (p = 0,002), por médicos con mayor especialización (p < 0,001) y cuando implicaban RNM de seguridad cuantitativa (p = 0,042). Los criterios STOPP/START detectaron el 65% de las PPI, encontrándose más PPI no relacionadas con estos criterios en institucionalizados que en hospitalizados (p < 0,001). Conclusiones: la IF en el equipo interdisciplinar logra resolver de forma significativa los PRM y RNM en el paciente mayor pluripatológico, contribuyendo a mejorar la calidad de su farmacoterapia. Es el primer estudio multicéntrico de estas características realizado en España.
Subject(s)
Pharmacists , Pharmacy , Aged , Aged, 80 and over , Female , Hospitalization , Humans , Male , Patient Care Team , Pharmacy Service, Hospital , Physicians , Prospective Studies , Spain , Treatment OutcomeABSTRACT
Objetivo: analizar el impacto de la Intervención Farmacéutica (IF), dentro del equipo asistencial que atiende al paciente mayor pluripatológico, en la evolución de los Problemas Relacionados con la Medicación (PRM) y los Resultados Negativos asociados con la Medicación (RNM). Estimar la prevalencia de PRM, RMN y Prescripciones Potencialmente Inadecuadas (PPI), y fármacos implicados, considerando las características de su ubicación asistencial. Método: estudio multicéntrico, prospectivo, de intervención, en pacientes mayores de 65 años pluripatológicos, institucionalizados u hospitalizados. El farmacéutico revisó la medicación crónica del paciente para detectar PRM y RNM y emitió recomendaciones al médico responsable del paciente, valorando posteriormente el efecto de dicha intervención. Los PRM y los RNM se clasificaron según el Tercer Consenso de Granada. Para la detección de PPI se utilizaron los Criterios STOPP/START. Las variables principales fueron: número IF realizadas y aceptadas por el médico. Resultados: se incluyeron 338 pacientes, presentando 326 (96,4%) algún PRM. Se detectaron 1.089 PRM, proponiéndose para su resolución 933 IF y aceptándose 651(69,9%). Las IF resolvieron 58,9% de los PRM, encontrándose asociación entre la IF y la resolución del PRM (p<0.001). Las IF fueron más aceptadas en pacientes institucionalizados que en hospitalizados (p=0,002), por médicos con mayor especialización (p<0,001) y cuando implicaban RNM de seguridad cuantitativa (p = 0,042). Los criterios STOPP/START detectaron el 65% de las PPI, encontrándose más PPI no relacionadas con estos criterios en institucionalizados que en hospitalizados (p<0,001). Conclusiones: la IF en el equipo interdisciplinar logra resolver de forma significativa los PRM y RNM en el paciente mayor pluripatológico, contribuyendo a mejorar la calidad de su farmacoterapia. Es el primer estudio multicéntrico de estas características realizado en España (AU)
Objective: to analyze the impact of Pharmacy Intervention (PI), within the healthcare team who manages elderly multi-pathological patients, regarding the evolution of Drug Related Problems (DRPs) and Negative Outcomes Associated with Medication (NOMs). To estimate the prevalence of DRPs, NOMs, and Potentially Inappropriate Prescriptions (PIPs), and the drugs involved, considering the characteristics of their healthcare location. Method: multicenter, prospective study, on >65-year-old patients with multiple pathologies, either institutionalized or hospitalized. The Pharmacist reviewed the chronic medication of the patient in order to detect DRPs and NOMs, and issued recommendations to the physician responsible for the patient, and this intervention was subsequently evaluated. DRPs and NOMs were classified according to the Third Consensus of Granada. The STOPP/START Criteria were used for PIP detection. The primary variables were: number of PIs conducted and accepted by the physician. Outcomes: 338 patients were included, and 326 (96.4%) presented some DRP. 1089 DRPs were detected, with 983 PIs suggested for their solution, and 651 (69.9%) of these were accepted. PIs solved 58.9% of DRPs, and an association was found between PI and the solution for the DRP (p<0.001). PIs were more accepted in institutionalized than in hospitalized patients (p=0.002), by physicians with a higher specialization (p<0.001) and when they involved quantitative safety NOMs (p=0.042). The STOPP/START Criteria detected 65% of PIPs, and more PIPs not associated with these criteria were found in institutionalized than in hospitalized patients (p<0.001). Conclusions: pharmacy Intervention within the multidisciplinary team can solve in a significant way both DRPs and NOMs in elderly multi-pathological patients, and thus help to improve the quality of their pharmacological therapy. This is the first multicenter clinical trial with these characteristics that has been conducted in Spain (AU)
