ABSTRACT
INTRODUCTION: Medication history assessment during hospital admissions is an important element in the medication reconciliation process. It ensures continuity of care and reduces medication errors. OBJECTIVES: This study aimed to determine the incidence of unintentional discrepancies (medication errors), types of medication errors with its potential severity of patient harm and acceptance rate of pharmaceutical care interventions. METHODS: A four-month cross-sectional study was conducted in the general medical wards of a tertiary hospital. All newly admitted patients with at least one prescription medication were recruited via purposive sampling. Medication history assessments were done by clinical pharmacists within 24 hours or as soon as possible after admission. Pharmacist-acquired medication histories were then compared with in-patient medication charts to detect discrepancies. Verification of the discrepancies, interventions, and assessment of the potential severity of patient harm resulting from medication errors were collaboratively carried out with the treating doctors. RESULTS: There were 990 medication discrepancies detected among 390 patients recruited in this study. One hundred and thirty-five (13.6%) medication errors were detected in 93 (23.8%) patients (1.45 errors per patient). These were mostly contributed by medication omissions (79.3%), followed by dosing errors (9.6%). Among these errors, 88.2% were considered "significant" or "serious" but none were "life-threatening." Most (83%) of the pharmaceutical interventions were accepted by the doctors. CONCLUSION: Medication history assessment by pharmacists proved vital in detecting medication errors, mostly medication omissions. Majority of the errors intervened by pharmacists were accepted by the doctors which prevented potential significant or serious patient harm.
Subject(s)
Medication Errors , Patient Admission , Cross-Sectional Studies , Hospitalization , Humans , Medication Errors/prevention & control , Medication Reconciliation/methods , PharmacistsABSTRACT
Background: Proton-pump inhibitors (PPI) and histamine-2 receptor antagonists (H2RA) are common acid suppressants used in gastrointestinal disorders. The trend of usage in Malaysia has changed from predominantly H2RA to PPI from 2007 to 2008, 3.46 versus 2.87 and 2.99 versus 3.24 DDD (Defined Daily Dose)/1000 population/day respectively. This raises concerns as PPI overutilization amounts to higher cost expenditure and are associated with various untoward consequences such as Clostridium difficile-associated diarrhea, pneumonia, and osteoporosis. Objectives: To evaluate the indication of acid suppression therapy (AST) and to look for predictors associated with the prophylactic use of PPI as compared to H2RA. Methods: Data collection was conducted via a standardized surveillance form over a 2-month period in the general medical wards of Sarawak General Hospital. All patients who received at least one dose of PPI or H2RA in any dosage form were included in the study. Appropriateness of prophylaxis was determined using current available guidelines. Selected risk factors were analysed using simple logistic regression to look for predictors associated with the choice of PPI in prophylactic AST. Results: Out of 212 cases in the present cohort, about three quarters (75.5%, n=160) of acid suppressants were given as prophylaxis. Over half of these did not have appropriate indications for prophylactic AST (58.1%, n=93). Among all cases given prophylactic AST, 75.0% (n=120) of them were given PPI. Renal insufficiency was identified as the only predictor associated with the use of prophylactic PPI in preference to H2RA (OR=2.86, 95%CI 1.21:6.72, p=0.011). Conclusion: Inappropriate prophylactic AST is a major concern and may even be underestimated due to the lack of appropriate guidelines. More data is required to guide the selection between PPI and H2RA, specifically the more cost-effective use of H2RA in patients with lower gastrointestinal risk or in whom PPI has no clear advantage (AU)
Antecedentes: Los inhibidores de la bomba de protones (PPI) y los antagonistas de los receptores de histamina-2 (H2RA) son antiácidos comunes que se usan en desordenes gastrointestinales. La tendencia de uso en Malasia ha cambiado de la predominancia de H2RA a PPI entre 2007 y 2008 de 3,46 vs. 2,87 y 2,99 vs. 3,24 DDD (Dosis Diarias Definida)/1000 habitantes/día, respectivamente. Esto preocupa ya que la sobreutilización de PPI produce mayores costes y están asociados a varias consecuencias indeseadas como diarrea asociada a Clostridium difficile, neumonía, y osteoporosis. Objetivos: Evaluar la indicación del tratamiento de supresión ácida (AST) y buscar predictores asociados con el uso de PPI comparados con H2RA. Métodos: Se recogieron datos mediante un formulario de vigilancia estandarizado durante 2 meses en los servicios de medicina heneral del Hospital General de Sarawak. Todos los pacientes que recibieron, al menos una dosis de PPI o de H2RA en cualquier forma fueron incluidos en el estudio. La adecuación del tratamiento fue determinada usando las guías disponibles actualmente. Se analizaron los factores de riesgo usando una regresión logística simple para buscar predictores asociados con la elección de PPI en AST profiláctica. Resultados: De los 200 casos presentes en la cohorte, cerca de tres cuartos (75,5; n=160) de los antiácidos fueron usado como profilácticos. Más de la mitad de ellos no tenían una indicación apropiada para AST profiláctica (58,1%, n=93). Entre todos los casos con AST profiláctica, el 75,0% (n=120) eran PPI. La insuficiencia renal fue el factor asociado con el uso de profilaxis con PPI en preferencia a los H2RA (OR=2,86; 95%CI 1,21:6,72, p=0,011). Conclusión: La AST profiláctica inadecuada es una gran problema y podría estar subestimada debido a la ausencia de guías apropiadas. Se requieren más datos para guiar la selección entre PPI y H2RA, específicamente el uso más coste-efectivo de los H2RA en pacientes con riesgo gastrointestinal bajo, o en los que no hay una clara ventaja de los PPI (AU)
