Abstract
BackgroundMedication errors remained among the top 10 leading causes of death worldwide. Furthermore, a high percentage of medication errors are classified as medication discrepancies. This study aimed to identify and quantify the different types of unintentional medication discrepancies among hospitalized hypertensive patients; it also explored the predictors of unintentional medication discrepancies among this cohort of patients.MethodsThis was a prospective observational study undertaken in a large teaching hospital. A convenience sample of adult patients, taking ≥4 regular medications, with a prior history of treated hypertension admitted to a medical or surgical ward were recruited. The best possible medication histories were obtained by hospital pharmacists using at least two information sources. These histories were compared to the admission medication orders to identify any possible unintentional discrepancies. These discrepancies were classified based on their severity. Finally, the different predictors affecting unintentional discrepancies occurrence were recognized.ResultsA high rate of unintentional medication discrepancies has been found, with approximately 46.7% of the patients had at least one unintentional discrepancy. Regression analysis showed that for every one year of increased age, the number of unintentional discrepancies per patient increased by 0.172 (P = 0.007), and for every additional medication taken prior to hospital admission, the number of discrepancies increased by 0.258 (P= 0.003). While for every additional medication at hospital admission, the number of discrepancies decreased by 0.288 (P < 0.001). Cardiovascular medications, such as diuretics and beta-blockers, were associated with the highest rates of unintentional discrepancies in our study. Medication omission was the most common type of the identified discrepancies, with approximately 46.1% of the identified discrepancies were related to omission. Regarding the clinical significance of the identified discrepancies, around two-third of them were of moderate to high significance (n= 124, 64.2%), which had the potential to cause moderate or severe worsening of the patient´s medical condition.ConclusionsUnintentional medication discrepancies are highly prevalent among hypertensive patients. Medication omission was the most commonly encountered discrepancy type. Health institutions should implement appropriate and effective tools and strategies to reduce these medication discrepancies and enhance patient safety at different care transitions. Further studies are needed to assess whether such discrepancies might affect blood pressure control in hypertensive patients.
Highlights
Despite multidisciplinary efforts and collaborations to ensure patient safety, medication errors remained among the top 10 leading causes of death worldwide [1]
Study design, and participants This prospective cross-sectional observational study recruited hypertensive patients admitted to the internal medicine and general surgery departments at Jordan University Hospital (JUH), the largest tertiary teaching hospital in Jordan
During the study period, a total of 382 patients were screened for their eligibility criteria; of these, two patients were excluded since they were less than 18 years, 57 patients had less than four medications, and 64 patients do not have hypertension
Summary
Despite multidisciplinary efforts and collaborations to ensure patient safety, medication errors remained among the top 10 leading causes of death worldwide [1]. Medication discrepancies are defined as unexplained changes among regimens across different care sites [3]. They are classified as unintentional and intentional discrepancies, and the latter sub-classified into documented or undocumented [4, 5]. Unintentional discrepancies are considered medication errors that need to be prevented or resolved. They are classified into several categories: omission of a required drug previously used, the addition of a medication not previously used and not justified by the patient’s clinical condition, duplication of medications, dosage discrepancies, frequency discrepancies, administration route discrepancies, or dosage form discrepancies [4, 5]. This study aimed to identify and quantify the different types of unintentional medication discrepancies among hospitalized hypertensive patients; it explored the predictors of unintentional medication discrepancies among this cohort of patients
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