Medication discrepancies in a hospital in Southern Brazil:
the importance of medication reconciliation for patient safety
DOI:
https://doi.org/10.1590/s2175-979020200004181064Keywords:
Patient Safety. Drug Use. Medication Reconciliation. Medication Errors.Abstract
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.
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Alfaras I, Di Germanio C, Bernier M, Csiszar A, Ungvari Z, Lakatta EG, et al. Pharmacological strategies to retard cardiovascular aging. Circ Res. 2016;118(10):1626-42.
Andreoli L, Alexandra JF, Tesmoingt C, Eerdekens C, Macrez A, Papo T, et al. Medication reconciliation: a prospective study in an internal medicine unit. Drugs Aging. 2014;31(5):387-9.
Armor BL, Wight AJ, Carter SM. Evaluation of adverse drug events and medication discrepancies in transitions of care between hospital discharge and primary care follow-up. J Pharm Pract. 2014;29(2):132-7.
Beckett RD, Crank CW, Wehmeyer A. Effectiveness and feasibility of pharmacist-led admission medication reconciliation for geriatric patients. J Pharm Pract. 2012;25(2):136-41.
Bishop MA, Cohen BA, Fashp MS, Billings LK, Thomas EV. Reducing errors through discharge medication reconciliation by pharmacy services. Am J Health Syst Pharm. 2015;72(17 Suppl 2):S120-6.
Cater SW, Luzum M, Serra AE, Arasaratnam MH, Travers D, Martin IBK, et al. A prospective cohort study of medication reconciliation using pharmacy technicians in the emergency department to reduce medication errors among admitted patients. J Emergency Med. 2015;48(2):230-8.
Charlesworth CJ, Smit E, Lee DSH, Alramadhan F, Odden MC. Polypharmacy among adults aged 65 years and older in the United States: 1988-2010. J Gerontolog A Biol Sci Med Sci. 2015;70(8):989-95. doi:10.1093/gerona/glv013.
» https://doi.org/10.1093/gerona/glv013
Comino EJ, Harris MF, Islam MF, Tran DT, Jalaludin B, Jorm L, et al. Impact of diabetes on hospital admission and length of stay among a general population aged 45 year or more: a record linkage study. BMC Health Serv Res. 2015;15:12.
Coutinho ESF, Silva SD, Paiva CHA, Freitas GG, Miranda LP, Mendonça R. Confiabilidade da informação sobre uso recente de medicamentos em um estudo caso-controle de base hospitalar. Cad Saúde Pública. 1999;15(3):553-8.
Doerper S, Godet J, Alexandra JF, Allenet B, Andres E, Bedouch P, et al. Development and multi-centre evaluation of a method for assessing the severity of potential harm of medication reconciliation errors at hospital admission in elderly. Eur J Intern Med. 2015;26(7):491-7.
Ferreira NML, Rodrigues VMCP. Assessment of the impact of polypharmacy on funding for admission in a long-term care and maintenance unit. Rev Enf Ref. 2012;(6):17-24.
Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Waite L, Seibel MJ, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012;65(9):989-95.
Hellström LM, Bondesson A, Hoglund P, Eriksson T. Errors in medication history at hospital admission: prevalence and predicting factors. BMC Clin Pharmacol 2012;12:9.
Huynh C, Tomlin S, Jani Y, Solanki GA, Haley H, Smith RE, et al. An evaluation of the epidemiology of medication discrepancies and clinical significance of medicines reconciliation in children admitted to hospital. Arc Dis Child. 2016;101(1):67-71.
Johnson B, Streltzer J. Risks associated with long-term benzodiazepine use. Am Fam Physician. 2013;88(4):224-5.
Kalb K, Shalansky S, Legal M, Khan N, Ma I, Hunte G. Unintended medication discrepancies associated with reliance on prescription databases for medication reconciliation on admission to a general medical ward. Can J Hosp Pharm. 2009;62(4):284-9.
Leistikow I, Mulder S, Vesseur J, Robben P. Learning from incidents in healthcare: the journey, not the arrival, matters. BMJ Qual Saf. 2017 Mar;26(3):252-6.
Medication Reconciliation: A Learning Guide. 2009. https://meds.queensu.ca/central/assets/modules/mr/1.html Accessed 30 Set 2017.
» https://meds.queensu.ca/central/assets/modules/mr/1.html
Oliveira-Filho AD, Morisky DE, Costa FA, Pacheco Sara T, Neves SF, Lyra-Jr DP. Improving Post-Discharge Medication Adherence in Patients with CVD: A Pilot Randomized Trial. Arq Bras Cardiol. 2014;103(6):503-12.
Paci JF, Alfaro MG, Alonso FJR, San-Martín MIF. Prescripción inadecuada en pacientes polimedicados mayores de 64 años en atención primaria. Aten Primaria. 2015;47(1):38-47.
Page RL, Linnebur SA, Bryant LL, Ruscin JM. Inappropriate prescribing in the hospitalized elderly patient: Defining the problem, evaluation tools, and possible solutions. Clin Interv Aging. 2010;5:75-87.
Parand A, Dopson S, Renz A, Vincent C. The role of hospital managers in quality and patient safety: a systematic review. BMJ Open. 2014;4(9):e005055. https://doi.org/10.1136/bmjopen-2014-005055
» https://doi.org/10.1136/bmjopen-2014-005055
Pesquisa Nacional de Saúde 2013: percepção do estado de saúde, estilos de vida e doenças crônica - Brasil, Grandes Regiões e Unidades da Federação. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística, 2014.
Pippins JR, Gandhi TK, Hamann C, Ndumele CD, Labonville SA, Carty MG, et al. Classifying and predicting errors of inpatient medication reconciliation. J Gen Intern Med. 2008;23(9):1414-22.
Rodriguez VB, Delgado SE, Peinado I, Bermejo VT. Prevalence and risk factors for medication reconciliation errors during hospital admission in elderly patients. Int J Clin Pharm. 2016;38(5):1164-71.
Runciman W, Hibbert P, Thomson R, Schaaf TV, Sherman H, Lewalle P. Towards an International Classification for Patient Safety: key concepts and terms. Int J Qual Health Care. 2009;21(1):18-26.
Saint-German P, Ruelle M, Mary A, Sid Idris S, Hannat S, Pelloquin N, et al. The clinical impact of treatment discrepancies recorded for 200 patients in an acute geriatric unit. Rev Med Interne 2016;37(10):667-73.
Sheikhtaheri A. Near misses and their importance for improving patient safety. Iran J Public Health. 2014;43(6):853-54.
Tejal KG, Donald MB, Kaveh GS. Patient Safety at the Crossroads. JAMA. 2016;315(17):1829-30.
van Melle MA, Erkelens DCA, van Stel HF, de Wit NJ, Zward DL. Pilot study on identification of incidents in healthcare transitions and concordance between medical records and patient interview data. BMJ Open 2016;6(8):e011368.
World Health Organization. Fifty-fifth World Health Assembly. A55/13. Quality of care: patient safety. 2003. http://www.who.int/patientsafety/worldalliance/ea5513.pdf Accessed 20 Nov 2017.
» http://www.who.int/patientsafety/worldalliance/ea5513.pdf
World Health Organization. World Alliance for Patient Safety, Taxonomy: The Conceptual Framework for the International Classification for Patient Safety. 2009. http://www.who.int/patientsafety/taxonomy/icps_full_report.pdf Accessed 31 Jul 2017
» http://www.who.int/patientsafety/taxonomy/icps_full_report.pdf
World Health Organization. World Alliance for Patient Safety. 2015. Geneva. http://www.who.int/patientsafety/worldalliance/en/ Accessed 31 Oct 2017.
» http://www.who.int/patientsafety/worldalliance/en/
Zoni AC, Durán García MED, Jiménez Muñoz AB, Salomón Pérez R, Martin P, Herranz Alonso A. The impact of medication reconciliation program at admission in an internal medicine department. Eur J Intern Med 2012;23(8):696-700.
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