The Continuity of Chronic Medications in Multimorbid Patients during Perioperative Period: Retrospective Analysis

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Abstract

Background. Failure of continuity at care transitions results in 50% of all medication errors and up to 20% of adverse drug events (ADEs). In surgical patients medication errors occur more often than in medical patients due to perioperative corrections of medications and greater number of in-hospital transitions. The frequency of ADE in surgical patients varies from 2.3 to 27.7%.

Aims — to determine the prevalence and structure of unintentional discrepancies (UDs) in medications at admission to and discharge from surgery departments, report their potential clinical impact and analyse possible risk factors.

Methods. Retrospective observational study was conducted in a general hospital in Russia. The study included patients hospitalized for elective surgery in Surgical Departments from January to June 2019. The pre-admission Best Possible Medication History (BPMH) for every patient was obtained. The BPMHs were compared with admission medication orders and hospital discharge prescriptions to identify UDs. Detected UDs were analysed for potential ADE with severity evaluation.

Results. 206 patients were included, 55.83% were female, mean age 63.85 (±9.38), median of chronic medications was 3 drugs. At least one UD was detected in 70.87% of patients at admission and in 92.72% at discharge, respectively, with averages of 1.30 and 2.81 discrepancies per patient. Cardiovascular drugs were the most frequent class involved at both admission (72.2%) and discharge (68.05%) in UDs. The most often UDs at both admission (51.68%) and discharge (94.65%) were omissions, incorrect dose (22.47% and 2.25%), and additional medications (11.6% and 1.55%). UDs had the potential to cause significant ADEs in 81.27%, serious ADEs in 18.35% of cases. Only 0.37% of UDs could contribute to life-threatening ADEs. The relative risk of discrepancies in patients of 60 years and older was 1.292-fold higher; three and more chronic medications increase risk 1.565-fold; diabetic or thyroid medications increase risk 1.932-fold.

Conclusions. We reported on the first study of medication discrepancies conducted in Russian hospital. Estimated frequency, structure and risk factors of UDs in medications at admission to and discharge from surgery departments are similar to those from other countries. To decrease UDs in medications, implementation of medication reconciliation is needed.

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About the authors

Maria D. Nigmatkulova

Russian Medical Academy of Continuing Professional Education; General Medical Center of the Bank of Russia

Author for correspondence.
Email: mnigmatkulova@gmail.com
ORCID iD: 0000-0001-8840-4904
SPIN-code: 2263-3980

graduate student, clinical pharmacologist

Russian Federation, 66, Sevastopolskij ave., Moscow, 117647; 2/1, Barrikadnaya st., Moscow, 125993

E. B. Kleymenova

General Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional Education; Federal Research Center «Computer Science and Control» of the Russian Academy of Sciences

Email: e.kleymenova@gmail.com
ORCID iD: 0000-0002-8745-6195
SPIN-code: 2037-7164

MD, PhD

Russian Federation, 66, Sevastopolskii ave., Moscow, 117647; 2/1, Barrikadnaya st., Moscow, 125993; 44-2, Vavilova str., Moscow, 119333

Liubov P. Yashina

General Medical Center of the Bank of Russia; Federal Research Center «Computer Science and Control» of the Russian Academy of Sciences

Email: lyashina1@yandex.ru
ORCID iD: 0000-0003-1357-0056
SPIN-code: 1910-0484

PhD in Biology

Russian Federation, 66, Sevastopolskii ave., Moscow, 117647; 125993; 44-2, Vavilova str., Moscow, 119333

Dmitry A. Sychev

Russian Medical Academy of Continuing Professional Education

Email: dmitrysychevrmapo@gmail.com
ORCID iD: 0000-0002-4496-3680
SPIN-code: 4525-7556

MD, PhD, Professor

Russian Federation, 2/1, Barrikadnaya st., Moscow, 125993

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1. Fig. 1. Distribution of drug prescriptions by groups

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