Unjustified Discrepancies Research Articles

Conciliación de la medicación en el paciente hematológico ingresado

ObjectiveThe main objective was to analyze unjustified discrepancies during the medication reconciliation process in patients admitted to the Hematology Service of our hospital and the pharmaceutical interventions. As a secondary objective, to detect possible points of the procedure to be perfected with a view to protocolizing the medication reconciliation process in hematological patients that adapts to the conditions of our center. MethodsCross-sectional observational pilot study carried out in a reference hospital in hematology for a population of 800,000 inhabitants. Adult inpatients admitted to the Hematology Service between August and October 2022 whose medication had been reconciled were included. The main variables were: number and type of unjustified discrepancy, proposed pharmaceutical intervention, and acceptance rate. Results36 conciliation processes were analyzed, 34 admissions and 2 intrahospital transfer. 58.3% of the patients presented at least one unjustified discrepancy. 38 unjustified discrepancies were detected, with an acceptance of pharmaceutical interventions of 97.4%. The most common types of discrepancy were medication omission (56.8%) and drug interaction (24.3%). The most frequent pharmaceutical interventions were reintroducing medication (48.6%) and treatment discontinuation (16.2%). Polypharmacy and chemotherapy multiplied by 4 the probability of presenting drug interactions. ConclusionsThe most common unjustified discrepancies in the medication reconciliation process in hospitalized hematology patients are: Medication omission and drug interactions. The reintroduction of medication and suspension of the prescription are the most frequent accepted pharmaceutical interventions. Polypharmacy is related to an increase in unjustified discrepancies. The factors that promote the appearance of interactions are admissions to receive chemotherapy treatment and polypharmacy. The main point of improvement detected is the need to create a circuit that allows conciliation to be carried out on discharge. Medication reconciliation contribute to improving patient safety by reducing medication errors.

Decreasing insulin wastage in acute medical assessment units at Hamad General Hospital

Background: Insulin therapy is commonly used to control hyperglycemia in hospitalized diabetic patients. There are different delivery devices of Aspart and Glargine insulin which are available in 1000 IU vial and 300 IU Flexpen. As per the manufacturer's recommendations, insulin pre-filled pens are designed for single patient use only, whereas the vial form is intended for multidose administration for different patients, therefore, the selection amongst both forms of insulin will certainly impact the consumption cost. According to our observation, there was an unjustified prescribing discrepancy between both forms. Several studies have shown a decrease in insulin wastage associated reduction in acquisition costs when switching from pre-filled pens to vials1-3. Methods: This is a quality improvement project that aims to enhance prescribing insulin vials in acute medical units at Hamad General Hospital. Insulin consumption data were retrospectively reviewed between July 2020-May 2021. Data were obtained 3 months consecutively at baseline and post improvement interventions which consist of 2 steps. Step 1: educating physicians and nurses about the cost effectiveness of insulin delivery devices, and Step 2: Transitioning patients from insulin Flexpen to vials by an authorized pharmacist. The outcomes measures were related to insulin consumption and cost reduction. The process was measured by the amount of Flexpens dispensed. Results: From July-October 2020, 400 patients consumed 81500 IU of insulin Aspart and 58600 IU of insulin Glargine, with a total number of 297 Flexpens used. After implementing improvement intervention, insulin consumption for 551 patients from February – May 2021 reduced to 19200 IU (76.4%) for Aspart and 18900 IU (67.7%) Glargine (Figure 1), comparing with same interval period only 38 Flexpens were dispensed. Economically, the transition to insulin vials reduced the hospital cost by 71% (Table 1). Conclusion: Compared to Flexpen, insulin vial prescribing in hospitalized diabetic patients led to waste and cost consumption reduction of insulin.

РЕАЛИЗАЦИЯ КОНЦЕПЦИИ ЕДИНСТВА ЦИВИЛИСТИЧЕСКОГО ПРОЦЕССА В СОВРЕМЕННОМ ЗАКОНОДАТЕЛЬСТВЕ

The article provides a comparative analysis of the legal regulation of proof and evidence in civil and arbitration proceedings, administrative proceedings. From the point of view of the unity and differentiation of the civil procedural form, the problems of legal regulation of proof and evidence in three procedural regulations are considered. The author considers the concept of judicial law as a methodological basis for unification in the legal regulation of proof and evidence. Judicial law is considered as a possible basis for the unity of civil procedure, its main concepts are highlighted: the unity of the goals of civil procedure; the unity of the principles of civil procedure; systemic interconnection of its constituent elements. As a result of the study, the author came to the conclusion that there are unjustified discrepancies in the legal regulation of proof and evidence. The author deduces this conclusion from the analysis of the mechanism of proof, enshrined in three procedural rules, the study of the rules for the distribution of the burden of proof, the admissibility of evidence and the exclusion of evidence. Proposals have been made to improve the legal regulation of proof and evidence, aimed at eliminating unjustified discrepancies. Also, the study raises questions about determining the moment from which the evidence presented by the person participating in the case may lose legal force.

Medication reconciliation in orthopedic and neurological patients in a public hospital

Objective: To evaluate the discrepancies found by the clinical pharmacy service during medication reconciliations in patients hospitalized for orthopedics and neurology in a university hospital. Methods: A cross-sectional, descriptive and retrospective study was carried out from January to June 2018 with the patients followed-up by the clinical pharmacy service (orthopedics and neurology). Data was collected through medical charts and pharmacotherapeutic follow-up forms. The differences between the list of medications that the patient was using at home and the prescription from the hospital was classified as a discrepancy (justified or unjustified). Medical acceptance of the pharmaceutical interventions was assessed. The medications involved in the discrepancies were classified according to the ATC classification in its 1st level. Descriptive statistics was performed using the Excel program and Pearson’s chi-square test. Results: Of the 939 medications used by the patients, 673 (71.7%) presented discrepancies and in 371 (55.1%), unjustified discrepancies were found. Of the 507 patients included in the study, 154 (30.4%) presented at least one medication error. In 96.8% of the cases, the pharmaceutical interventions were performed, and acceptability was 30.6%, avoiding 110 errors. Medication omission was the most common type of discrepancy and the medical group most frequently involved was the cardiovascular system. Conclusions: Medication errors in admission to the orthopedics and neurology sectors are frequent, but they can be identified and solved through medication reconciliation, with professional clinical pharmacists able to perform it, collaborating for the safety of the patients.

Development and Evaluation of Medication Reconciliation Checklist Tool to Improve Patient Safety

Background: Medication reconciliation is a formal process for creating the most complete and accurate list possible of a patient's current medications and comparing the list to those in the patient record or medication orders. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. The lack of precise and complete information about patient's medicines is the most common contributing factor for the precipitation of patient safety problem around the globe. Objectives: To develop a medication reconciliation checklist tool and evaluate its utility in the assessment of medication discrepancies and contributing factors Methods: A prospective observational study was carried out in the selected departments at a tertiary care hospital. A checklist tool was prepared based on the critical parameters of the reconciliation approach which was used to assess drug discrepancies during care transition and were categorized under Justified and Unjustified medicine discrepancies. Results: A total of 200 cases were reviewed out of which164 cases were identified with the scope of reconciliation and were then followed. The observed discrepancies were categorized as follows; A total of Justified Discrepancies [27] were reported (Therapeutic Equivalence: 0, Clinical Preference: 1, Medical reason: 26), and Unjustified Discrepancies [113] (Omission errors: 31, Modification of dose: 16, Incorrect drugs: 61, Therapeutic Duplication: 4, Drug interactions: 1). Conclusion: The study concluded that medication reconciliation checklist tool was helpful in identifying medication discrepancies. Execution of the medication reconciliation process by a pharmacist can improve drug and patient safety.

A legal status of former owners in the restitution process in Serbia

Restitution or return of a confiscated property to the former owners can only be considered as a part of the complete reform process. In this regard, it has two major segments: the first refers to the elimination of previously committed injustice and the second one concerns the contribution to the overall changes in the property relations in order to initiate the increase of the economic efficiency. The process of the restitution in Serbia began to develop significantly after the privatization process had started. This unjustified discrepancy greatly affected the legal solutions, as well as the process of their implementation. The analysis of regulations and the practice arisen from them indicate the evident contradictions, inconsistencies and legal gaps in the normative work, which inevitably contributed to the different positions of the subjects in the process of restitution, which, in some cases, has had the elements of discrimination. So far there have been no announcements regarding the comprehensive, substantive changes within the legislation. This study aims to highlight the unsustainability of the current situation as well as the necessity to proceed with amending the existing laws in the restitution process.

Conciliación de medicación al ingreso mediante un programa de prescripción electrónica asistida

ObjectiveTo describe and to analyse a new method of integrated medicines reconciliation in an electronic prescribing program results. Method12-month, prospective, observational, non-randomized and uncontrolled study, in which all patients who were admitted, during that year, to a general hospital of 450 beds. The electronic prescribing program was used for medication reconciliation as a means to multidisciplinary approach (nurses, doctors, pharmacists). This reconciliation was done at the time of hospital admission and reconciliation errors were measured. ResultsA total of 23 701 patients were included, with 53 920 medications being reconciled, of which 48 744 (90.4%) had no discrepancies and 5 176 (9.6%) had discrepancies: 4 731 (8.7%) justified and 445 (0.8%) not justified. The majority of unjustified discrepancies were due to the drugs in use at home not recorded well on the hospital admission record in 310 (69.7%), prescription omissions in 105 (23.6%) and duplications in 30 (6.7%). In any case the reconciliation errors reached patients. ConclusionsUsing an electronic prescribing program and an interdisciplinary approach in the reconciliation of chronic medication, medication reconciliation at the time of hospital admission is achieved in 98% of patients, showing medication errors only in 1.3% of patients.

Estudio clínico de conciliación de la medicación al ingreso hospitalario en pacientes de las áreas de medicina interna y cirugía

Objetivos. Examinar el grado de complejidad farmacoterapeutico en pacientes cronicos ingresados. Analizar la conciliacion de la medicacion al ingreso hospitalario. Detectar el numero, naturaleza e impacto de los errores de conciliacion. Analizar el protocolo de conciliacion vigente y la aportacion del farmaceutico al mismo. Material y Metodos. Se analizo la medicacion de pacientes de medicina interna y cirugia durante un mes en una clinica privada. La historia farmacoterapeutica se obtuvo a partir de la historia clinica y los registros de dispensacion de medicamentos a las 48 horas post-ingreso. Se evaluaron las discrepancias de medicacion, los errores asociados a ellas y la calidad del protocolo de conciliacion. Resultados. Fueron incluidos 60 pacientes con 62,5 ± 17,2 anos de edad y con 2,7 ± 1,9 enfermedades cronicas por paciente. El numero de medicamentos habituales y hospitalarios por paciente fue 5,4 ± 2,8 y 6,0 ± 2,9 respectivamente. Se observaron 2,6 ± 2,5 discrepancias no justificadas por paciente y estas representaron el 33,5 %. El 49,3 % de los errores presentaron dano potencial asociado y 1,3 ± 1,9 alcanzaron a cada paciente. La calidad del protocolo aumenta hasta el 94 % con la intervencion del farmaceutico. Conclusiones. La farmacoterapia de los pacientes cronicos ingresados es compleja en el ambito comunitario y hospitalario. Existe un numero considerable de discrepancias no justificadas asociadas a errores graves al ingreso hospitalario. Los protocolos de conciliacion deben ser revisados para alcanzar en la practica una reduccion de los errores de medicacion y el farmaceutico debe tomar un papel activo en ellos.

Evaluation of medication reconciliation in a trauma unit

IntroductionThe aim of this study was to assess the rate of discrepancies in medication reconciliation on admission patients in a trauma unit, and identifying potential risk factors associated with these discrepancies. Materials and methodsA cross-sectional, observational study was carried out to identify reconciliation errors in a tertiary hospital during the period from May 1 to July 16 of 2012. Medication history of the patient was compared with home medication data collected on admission, to identify reconciliation errors. These were classified according to the type and severity of the discrepancies. Statistical analysis by logistic regression was performed, using the presence of discrepancies as dependent variable. ResultsThe study included 164 patients, and reconciliation errors were found in 48.8%, of which 14.4% were considered highly relevant. Around two-thirds (66.7%) of the patients admitted to the emergency department showed unjustified discrepancies compared to 44.8% in scheduled patients. In total, 153 reconciliation errors were identified, being omitted drug the most frequent type of discrepancies (72%). The risk of discrepancies increases by 33% for each drug added to the usual home treatment. ConclusionThis study demonstrates the lack of quality in home medication recording in patients admitted to the trauma unit.

A Prospective Cohort Study of Medication Reconciliation Using Pharmacy Technicians in the Emergency Department to Reduce Medication Errors among Admitted Patients

BackgroundThe collection of a complete, verified medication history is essential to patient safety. The involvement of clinical pharmacists has been shown to improve the completeness and accuracy of medication histories; however, to our knowledge, involvement of pharmacy technicians has not been studied. ObjectiveOur aim was to determine whether verification of medication histories by pharmacy technicians in the emergency department (ED) would result in fewer errors in inpatient medication regimens compared to verification by the admitting physician team. MethodsWe performed a prospective cohort study of adult ED patients admitted for continuing care. In the intervention group, medication reconciliation was performed by pharmacy technicians in the ED before the creation of physician admitting orders. In the control group, pharmacy technicians conducted their history taking later, after admission. Initial admitting orders were then compared to the pharmacy technicians' medication reconciliation taken before admission (intervention group) or after admission (control group). Medication discrepancies were classified and determined to be justified or unjustified. Unjustified discrepancies were rated for harm potential. ResultsIn our cohort of 113 intervention and 75 control subjects, the mean age was 55 years (standard deviation [SD] 16 years); 96 patients (51%) were male. In the intervention group, 566 changes to home medications were observed on admission; 352 (62%) were unjustified. Among controls, 406 changes to home medications were observed; 228 (56%) were unjustified. This difference was not statistically significant (p = 0.0586). The rate of unjustified medication changes per patient was likewise not significantly different (3.14 [SD 2.98] in interventions vs. 3.17 [SD 2.81] in controls; p = 0.9570). The rate of medical errors did not differ between study groups, nor did severity ratings of unjustified changes. ConclusionsMedication reconciliation by pharmacy technicians in the ED did not lead to a significant reduction in unjustified medication discrepancies.

Impacto de una aplicación informática en la mejora de la conciliación de la medicación al alta hospitalaria

Background and objectiveTo assess the impact of a software application to improve the quality of information concerning current patient medications and changes on the discharge report after hospitalization. To analyze the incidence of errors and to classify them. Material and method DesignQuasi-experimental pre / post study with non-equivalent control group study.Study population: Medical patients at hospital discharge.Intervention: implementation of a software application.Variables: Percentage of reconciled patient medication on discharge, and percentage of patients with more than one unjustified discrepancy. ResultsA total of 349 patients were assessed; 199 (pre-intervention phase) and 150 (post-intervention phase). Before the implementation of the application in 157 patients (78.8%) medication reconciliation had been completed; finding reconciliation errors in 99 (63.0%). The most frequent type of error, 339 (78.5%), was a missing dose or administration frequency information. After implementation, all the patient prescriptions were reconciled when the software was used. The percentage of patients with unjustified discrepancies decreased from 63.0% to 11.8% with the use of the application (p<.001). The main type of discrepancy found on using the application was confusing prescription, due to the fact that the professionals were not used to using the new tool. ConclusionsThe use of a software application has been shown to improve the quality of the information on patient treatment on the hospital discharge report, but it is still necessary to continue development as a strategy for improving medication reconciliation.

Evaluación de la conciliación de la medicación en una Unidad de Traumatología

IntroductionThe aim of this study was to assess the rate of discrepancies in medication reconciliation on admission patients in a trauma unit, and identifying potential risk factors associated with these discrepancies. Material and methodsA cross-sectional, observational study was carried out to identify reconciliation errors in a tertiary hospital during the period from May 1 to July 16 of 2012. Medication history of the patient was compared with home medication data collected on admission, to identify reconciliation errors. These were classified according to the type and severity of the discrepancies. Statistical analysis by logistic regression was performed, using the presence of discrepancies as dependent variable. ResultsThe study included 164 patients, and reconciliation errors were found in 48.8%, of which 14.4% were considered highly relevant. Around two-thirds (66.7%) of the patients admitted to the emergency department showed unjustified discrepancies compared to 44.8% in scheduled patients. In total, 153 reconciliation errors were identified, being omitted drug the most frequent type of discrepancie (72%). The risk of discrepancies increases by 33% for each drug added to the usual home treatment. ConclusionThis study demonstrates the lack of quality in home medication recording in patients admitted to the trauma unit.

Pharmacist-led medication reconciliation to reduce discrepancies in transitions of care in Spain

Medication errors are one of the main causes of morbidity amongst hospital inpatients. More than half of medication errors occur at 'interfaces of care', when patients are discharged or transferred to the care of another physician. Medication reconciliation is the process of reviewing patients' complete previous medication regimen, comparing it with current prescriptions, and analysing and resolving any discrepancies that the pharmacist does not believe to be intentional (unjustified discrepancies). To quantify and analyse reconciliation unjustified discrepancies detected by a pharmacist in patients admitted to an internal medicine unit (IMU) over a 3-year period. The hospital employs a pharmacist who acts as a link between the primary care services and the internal medicine specialist care unit. A retrospective descriptive study on the reconciliation discrepancies found was carried out. Medication reconciliation was performed upon admission in all patients transferred from the Accident and Emergency department (A&E) and admitted to the IMU, and also at the time of discharge. The interventions were categorised based on the consensus document on terminology and medication classification published by the Spanish Society of Hospital Pharmacy. Number of patients with unjustified discrepancies, also known as reconciliation errors. 2,473 patients had their treatment reviewed at the time of admission and 1,150 at discharge. 866 reconciliation discrepancies were detected in 446 patients (1.94 per patient). 807 (93 %) were accepted by the prescribing physician and classified as reconciliation errors. 16.8 % of patients had at least one reconciliation error: 63.8 % of these errors were incomplete prescriptions, 16.6 % were medication omissions and 10.5 % were errors in dosage, administration method and/or frequency. The rate of medication errors found in this study is low compared with other similar studies. The most common error was "incomplete prescriptions", most of them generated by the Accident and Emergency department. A computerised clinical history would help to decrease the number of reconciliation errors. Pharmacist interventions focused on medication reconciliation are well accepted by physicians, improving the quality of clinical histories and decreasing the number of medication errors that occur across transitions in patient care.

GRP-102 Integration of Medicines reconciliation into an Electronic Prescribing Programme

BackgroundReconciliation is the process of assessing a listing of the patients’ previous medicines with the current prescription. Around 46% of medicines errors in hospitals are reconciliation errors.PurposeTo evaluate the effectiveness...

Medication errors associated with reconciliation in a hospital with computerised physician order entry system with access to primary care treatment

BackgroundA recently introduced computerised physician order entry system (CPOES) in hospital and a primary care electronic record system help prescribing and provide information about patients' medicines. These tools should improve...

Medicines reconciliation in hospital patients coordinated with primary care†

BackgroundIn the literature the authors find many types of reconciliation studies, only at admission, only at discharge or at discharge and later in primary care. The data on discrepancies can...

Quality of Home Medication Collection in the Emergency Department: Reconciliation Discrepancies

IntroductionThe objective of the study was to assess home medication data collected at the emergency department in a tertiary hospital. It also aimed to identify whether any possible deficiencies in this collection were translated as reconciliation errors on admission, to analyse and classify these data and identify the pharmacological groups involved. MethodsA prospective observational study was carried out which analysed the pharmacotherapeutic data collected at the emergency department. Patients who were admitted to the Pneumology and Internal Medicine wards at the Miguel Servet University Hospital in Zaragoza were included. A list of the home drugs taken before the hospital stay was compiled, assessing whether the quality deficiencies in data collected in the emergency department translated as reconciliation errors at admission. Unjustified discrepancies were considered and classified in line with the criteria of the consensus document on terminology, classification and assessment of the drug reconciliation programmes for 2009. ResultsWe included 136 patients, finding reconciliation errors in 86.8%. The total number of reconciliation errors found was 519. The most frequent types were: omitting a drug, missing dose information, missing administration frequency information. Almost 40% of the reconciliation errors found in the Internal Medicine ward were not resolved, which was double to that of the Pneumology ward. Most discrepancies were found for the Digestive System and Metabolism group (24%). ConclusionsThe percentage of patients that experienced reconciliation errors was high (86%), observing an important opportunity to improve at patient admission to the emergency department.

Calidad de la recogida de la medicación domiciliaria en urgencias: discrepancias en la conciliación

Introduction The objective of the study was to assess home medication data collected at the Emergency Department in a tertiary hospital. It also aimed to identify whether any possible deficiencies in this collection were translated as reconciliation errors on admission, to analyse and classify these data and identify the pharmacological groups involved. Method A prospective observational study was carried out which analysed the pharmacotherapeutic data collected at the Emergency Department. Patients who were admitted to the Pneumology and Internal Medicine wards at the Miguel Servet University Hospital in Zaragoza were included. A list of the home drugs taken before the hospital stay was compiled, assessing whether the quality deficiencies in data collected in the emergency department translated as reconciliation errors at admission. Unjustified discrepancies were considered and classified in line with the criteria of the consensus document on terminology, classification and assessment of the drug reconciliation programmes for 2009. Results We included 136 patients, finding reconciliation errors in 86.8%. The total number of reconciliation errors found was 519. The most frequent types were: omitting a drug, missing dose information, missing administration frequency information. Almost 40% of the reconciliation errors found in the Internal Medicine ward were not resolved, which was double that of the Pneumology ward. Most discrepancies were found for the Digestive System and Metabolism group (24%). Conclusions The percentage of patients that experienced reconciliation errors was high (86%), observing an important opportunity to improve at patient admission to the Emergency Department.

Medication discrepancies at discharge from an internal medicine service

Background Medication errors most commonly occur at the time of medication prescribing and particularly at the moment of the transitions of care. The objectives of this study were to identify and characterize the discrepancies between the physicians' discharge medication orders and the medication lists at admission obtained by an internal medicine specialist physician in a general internal medicine service. Methods This descriptive, retrospective, study was carried out at a tertiary care university teaching hospital in Spain. It was based on the review of non selected, consecutive, hospital discharge reports. Discrepancies were identified, categorized and characterized through the analysis of the information (medication lists, laboratory tests results, diagnosis, and clinical evolution) contained in them. Results We analyzed 954 discharge reports. In the medication reconciliation process, we find discrepancies in 832 (87.2%) of them. Justified discrepancies were found in 828 (86.8%) reports and unjustified discrepancies in 52 (5.4%). Omission of a medication was the most frequent medication error detected in 86.4% of cases, followed by incomplete prescription (9.6%). The number of diagnosis, the length of hospital stay and the number of permanent medications at admission were the characteristics of cases associated with medication discrepancies in multivariate linear regression ( P < 0.01). Conclusions Although considering the limitations in its design, it is remarkable the low number of medication errors detected in our study. Appropriate routines to ensure an accurate medication history collection and a methodical elaboration of the medication list at discharge, when performed by trained internists, are important for an adequate medication reconciliation process.

Abordaje interdisciplinar de la conciliación de la medicación crónica al ingreso en un hospital

Objectives To reduce medication errors and prevent interactions and duplications using a Chronic Medication Reconciliation Program on patient admission. To create an updated reconciled medications by resolving discrepancies within 24 hours of admission to the ward. To ensure the necessary medication is given at the dose, route and at the correct intervals depending on the clinical situation of the patient. Material, Patients and Methods Prospective observational, non-randomised and uncontrolled study during the period from October 2008 to March 2009 (both included) in a primary level local hospital, in which all patients admitted to the hospital who met the inclusion criteria had their chronic medication reconciled on hospital admission. Results A total of 469 patients were included, with 3609 medications being reconciled, of which 2466 (68.33%) had discrepancies: 667 (27.0%) unjustified and 1799 (72.9%) justified. There were no discrepancies in 1143 (31.6%). The majority of unjustified discrepancies were prescription omissions in 662 (26.8%) and duplications in 5 (0.2%). On 640 (25.9%) occasions the error reached the patient without causing any harm, and only 4 (0.16%) required monitoring. Discussion Using an interdisciplinary approach in the reconciliation of chronic medication, many medication errors have been detected and neutralised. Discrepancies have been resolved, neutralising omissions, interactions and duplications. Drugs with a low intrinsic pharmacological value were withdrawn, and the list of reconciled medications recorded in the clinical notes.