Prospective Observational Study On Medication Reconciliation And Admission Discrepancies In A Hospital

Medication reconciliation, a crucial process in healthcare, involves comparing a patient's medication orders with their existing medications to avoid discrepancies and enhance patient safety. This prospective observational study explores the significance of medication reconciliation during admission, aiming to categorize and assess the severity of medication discrepancies for a period of 6 months at a Tertiary Care Hospital in Mangalore and included 600 participants out of which 255 met inclusion criteria. The study revealed that only 255 patients had medication discrepancies. Most patients were aged above 60 years (55.29%), emphasizing the vulnerability of geriatric individuals to chronic diseases. Analyzing comorbidities showed that patients with 2 comorbidities (47.84%) was predominant. 63.52% of prescriptions contained 1-5 medications, with polypharmacy increasing the likelihood of discrepancies. Medication discrepancies were categorized as intentional during admission (53.23%) and unintentional (46.76%). Drug omission was the most common unintentional discrepancy (45.15%), followed by altered route (19.57% during admission) and altered dose (17.05%). Severity classification revealed that the majority of errors belonged to category C (52.54%), indicating errors reaching the patient but not causing harm. The present study shows that medication reconciliation is essential for reducing medication errors and enhancing patient safety. The study's findings advocate for the implementation of robust medication reconciliation protocols across all healthcare facilities, with an emphasis on utilizing the expertise of pharmacists and pharmacy students. By doing so, healthcare systems can ensure optimal patient outcomes and improve overall healthcare quality药物重整（medication reconciliation）是医疗照护中的关键流程，其核心为比对患者的用药医嘱与现有用药方案，以规避用药差错、提升患者安全。本项前瞻性观察性研究以芒格洛尔的某三级医院为研究地点，针对入院期间的药物重整工作开展意义探究，研究周期为6个月，旨在对用药差错进行分类并评估其严重程度；研究共纳入600名受试者，其中255名符合纳入标准。研究结果显示，共有255名患者存在用药差错。其中多数患者年龄超过60岁（占比55.29%），凸显出老年群体罹患慢性疾病的易感性。对合并症（comorbidities）的分析表明，存在2种合并症的患者占比最高（47.84%）。63.52%的处方包含1至5种药物，而多重用药（polypharmacy）会提升用药差错发生的概率。用药差错可分为入院时的有意性差错（53.23%）与无意性差错（46.76%）。其中药物遗漏（drug omission）是最常见的无意性差错类型，占比达45.15%，其次为给药途径变更（占19.57%）与给药剂量变更（占17.05%）。严重程度分级结果显示，多数差错属于C类（52.54%），即差错已送达患者但未造成伤害。本研究证实，药物重整对于减少用药差错、提升患者安全至关重要。研究结果呼吁所有医疗机构推行完善的药物重整流程规范，并强调应发挥药师与药学专业学生的专业职能。通过落实上述举措，医疗系统可保障患者获得最优诊疗结局，同时提升整体医疗服务质量。