ABSTRACT
OBJECTIVE: To quantify and to classify the discrepancies between the admission treatment and the usual patient treatment. To determine the variables that predict those patients that will have more benefit from medication reconciliation. MATERIAL AND METHODS: A prospective medication reconciliation study was conducted in the Vascular Surgery Unit from March 2014 to December 2014. When the patients were admitted to the Vascular Surgery Unit, they were informed about the study and asked to prepare information about their chronic treatment. The pharmacist then checked their clinical records, outpatient prescriptions, and also interviewed the patient, obtaining the best pharmacotherapeutic history available. The discrepancies with the admission treatment were written into the patient electronic clinical records. Finally, the physician classified the discrepancies, and changed the treatment, if needed. The statistical analysis included a comparison between patients with and without a non-justified discrepancy (NJD). The statistically different characteristics were used to plot Receiver Operating Characteristic curves, in order to determine the sensitivity and the specificity of these variables to select patients with discrepancies. RESULTS: A total of 380 patients were included. There were 845 non-justified, 600 justified non-documented, and 439 justified documented discrepancies. At least one NJD was identified in 293 patients (77%), with 65 patients (17%) having only justified discrepancies, and 22 patients (6%) having no discrepancies. NJD were: different dose, route or schedule (51%), omission (39%), wrong drug (8%) and commission (2%). The variables associated with discrepancies were number of chronic medications drugs and provider of information. CONCLUSIONS: In most studies, omission is the most frequent error. In contrast, in our study the most frequent error is different dose, route, or schedule. The variable that allows selecting patients at higher risk of discrepancies is the number of chronic drugs. This risk is also increased if the patients are not the manager of their own medication.
Subject(s)
Medication Reconciliation , Patient Admission , Adult , Aged , Aged, 80 and over , Cardiology , Drug Prescriptions , Electronic Prescribing , Female , Hospital Departments , Humans , Male , Medication Errors/prevention & control , Medication Reconciliation/methods , Medication Reconciliation/organization & administration , Middle Aged , Patient Selection , Prospective Studies , Quality Improvement , ROC Curve , Surgery Department, HospitalABSTRACT
Introducción. En la endarterectomía carotídea (EC) existe un fuerte impacto de la denominada medicina basada en la evidencia (MBE); no obstante, persisten numerosas controversias de índole técnico que generan incertidumbre entre los cirujanos. A mayor incertidumbre, mayor variabilidad de práctica clínica (VPC), y, en consecuencia, diferentes resultados. Objetivo. El presente trabajo pretende valorar el grado de VPC, entre los cirujanos vasculares de CastillaLeón (de similar epidemiología, oferta sanitaria y recursos), en la EC. Materiales y métodos. Se pasa un cuestionario, con dos tipos de preguntas, a todos los miembros de la Sociedad Castellano-Leonesa de Angiología y Cirugía Vascular (SOCLACIVAS). Cuatro preguntas tratan sobre conocimientos, donde se valora la concordancia entre la respuesta dada por el encuestado y la avalada por la MBE, y 11 sobre VPC, donde no existe consenso entre cuál es la mejor opción. Resultados. Participan 26 cirujanos vasculares con experiencia en la EC, de los cuatro servicios asistenciales existentes en Castilla-León (62 por ciento de los miembros SOCLACIVAS). El nivel de conocimientos-MBE de estos encuestados es del 79,8 por ciento (67,3-93,7 por ciento entre servicios). El grado medio de VPC encontrado fue del 32,5 por ciento (0-66,7 por ciento entre los distintos puntos investigados). La VPC es superior entre servicios que entre facultativos del mismo servicio. Conclusión. A similares pacientes (indicaciones) se aplican diferentes tratamientos (técnica anestesicoquirúrgica), lo que quizá puede condicionar el destino de los resultados (AU)
