Study highlights extent of medication errors in hospitals
http://www.100md.com
《英国医生杂志》
A systematic review by Canadian researchers of 22 studies including 3755 patients showed that errors in prescription medication histories at hospital admission were "disturbingly common and potentially harmful to patients." Such errors occurred in up to 67% of cases in the studies, which were published between 1966 and April 2005 (CMAJ 2005;173:510-5).
Between 27% and 54% of patients had at least one medication history error and 19-75% of the discrepancies were unintentional. In six of the studies (n=588 patients) the investigators estimated that 11-59% of the medication history errors were clinically important.
The investigators searched Medline, Embase and CINAHL for the articles and bibliographies of papers subsequently retrieved from the search. They reviewed all published studies with quantitative results that compared prescription medication histories obtained by physicians at the time of hospital admission with comprehensive medication histories. Three reviewers independently ed data on methodological features and results.
Examples of medication history errors included:
A patient admitted because of recurrent syncope was taking 125 micrograms of digoxin a day before admission to hospital, but this was not recorded in the drug history
A stroke patient with aphasia was admitted to hospital, and the family gave his drugs, which included propafenone. The drugs were given. But once recovered, the patient said that he had been told several months before to stop taking propafenone
A patient admitted for diabetes management was taking 5 milligrams of amlodipine twice a day. The treating doctor ordered 5 milligrams of amlodipine just once a day
A patient admitted with gastrointestinal bleeding was taking 12.5 milligrams of metoprolol twice a day before admission to hospital, but the drug history and orders indicated 50 milligrams of metoprolol twice a day.
Three studies included errors in prescription and non-prescription drug history; one showed that 41% of the errors were clinically important. Another showed that 3% of the patients had drugs omitted from their drug history that were considered to be "life saving" and that 24% of the patients would have gained "significant benefit" from the omitted drugs. The third study found that 22% of the errors could have caused harm had the drug been continued in hospital and that 59% potentially could cause harm if continued beyond discharge.
Prescription drugs most often involved in errors were cardiovascular agents (for example, nitrates, digoxin, or b blockers), sedatives (benzodiazepines), and analgesics (non-steroidal anti-inflammatory drugs and opioids).
The study indicates a need for a systematic approach to ensuring that doctors take accurate drug histories at hospital admission and says that doctors may benefit from additional training.
Pharmacists could be routinely involved in the task and patients and family members could help by bringing drug information to the hospital. Integrated community pharmacy databases accessible to hospital staff could also enhance the accuracy of drug histories.(Quebec David Spurgeon)
Between 27% and 54% of patients had at least one medication history error and 19-75% of the discrepancies were unintentional. In six of the studies (n=588 patients) the investigators estimated that 11-59% of the medication history errors were clinically important.
The investigators searched Medline, Embase and CINAHL for the articles and bibliographies of papers subsequently retrieved from the search. They reviewed all published studies with quantitative results that compared prescription medication histories obtained by physicians at the time of hospital admission with comprehensive medication histories. Three reviewers independently ed data on methodological features and results.
Examples of medication history errors included:
A patient admitted because of recurrent syncope was taking 125 micrograms of digoxin a day before admission to hospital, but this was not recorded in the drug history
A stroke patient with aphasia was admitted to hospital, and the family gave his drugs, which included propafenone. The drugs were given. But once recovered, the patient said that he had been told several months before to stop taking propafenone
A patient admitted for diabetes management was taking 5 milligrams of amlodipine twice a day. The treating doctor ordered 5 milligrams of amlodipine just once a day
A patient admitted with gastrointestinal bleeding was taking 12.5 milligrams of metoprolol twice a day before admission to hospital, but the drug history and orders indicated 50 milligrams of metoprolol twice a day.
Three studies included errors in prescription and non-prescription drug history; one showed that 41% of the errors were clinically important. Another showed that 3% of the patients had drugs omitted from their drug history that were considered to be "life saving" and that 24% of the patients would have gained "significant benefit" from the omitted drugs. The third study found that 22% of the errors could have caused harm had the drug been continued in hospital and that 59% potentially could cause harm if continued beyond discharge.
Prescription drugs most often involved in errors were cardiovascular agents (for example, nitrates, digoxin, or b blockers), sedatives (benzodiazepines), and analgesics (non-steroidal anti-inflammatory drugs and opioids).
The study indicates a need for a systematic approach to ensuring that doctors take accurate drug histories at hospital admission and says that doctors may benefit from additional training.
Pharmacists could be routinely involved in the task and patients and family members could help by bringing drug information to the hospital. Integrated community pharmacy databases accessible to hospital staff could also enhance the accuracy of drug histories.(Quebec David Spurgeon)