Patients with diabetes are at high risk of serious medication errors at hospital: Interest of clinical pharmacist intervention to improve healthcare.

Cyril Breuker, Océane Abraham, Laura di Trapanie, Thibault Mura, Valérie Macioce, Catherine Boegner, Anne Jalabert, Maxime Villiet, Audrey Castet-Nicolas, Antoine Avignon, Ariane Sultan

Journal: European journal of internal medicine 2017;38():38-45

PMID: 28007439

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Abstract

BACKGROUND

Medication errors (ME) are major public health issues in hospitals because of their consequences on patients' morbi-mortality. This study aims to evaluate the prevalence of ME at admission and discharge of hospitalization in diabetic and non-diabetic patients, and determine their potential clinical impact.

METHOD

This prospective observational study was conducted at the Endocrinology-Diabetology-Nutrition Department. All adult patients admitted were eligible. A total of 904 patients were included, of which 671 (74.2%) with diabetes mellitus. Clinical pharmacists conducted medication reconciliation: they collected the Best Possible Medication History and then compared it with admission and discharge prescriptions to identify medication discrepancies. ME were defined as unintended medication discrepancies if corrected by the physician.

RESULTS

Clinical pharmacists allowed correcting ME in 176/904 (19.5%) patients at admission and in 86/865 (9.9%) patients at discharge. More than half of ME were omissions. Diabetic patients were more affected by ME than non-diabetic patients, both at admission (22.1% vs 12.0%, p<0.001) and at discharge (11.4% vs 5.7%, p=0.01). The diabetic group also had more potentially severe and very severe ME. Diabetic patients had on average twice more medications than non-diabetic patients (8.7±4.5 vs 4.4±3.4, p<0.001). The polypharmacy associated with diabetes, but not diabetes mellitus itself, was identified as a risk factor of ME.

CONCLUSIONS

The intervention of clinical pharmacists allowed correcting 378 ME in 25.8% of the cohort before they caused harm. Clinicians, pharmacists and other health care providers should therefore work together to improve patients' safety, in particular in high-risk patients such as diabetic patients.

Address: Clinical Pharmacy Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 371 Avenue du Doyen G. Giraud, 34295 Montpellier, France. Electronic address: [email protected].; Clinical Pharmacy Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France.; Clinical Research and Epidemiology Unit, University Hospital, 39 Avenue Charles Flahault, 34295 Montpellier, France.; Endocrinology-Diabetology-Nutrition Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France.; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 371 Avenue du Doyen G. Giraud, 34295 Montpellier, France; Endocrinology-Diabetology-Nutrition Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France.

DOI: 10.1016/j.ejim.2016.12.003

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MeSH Terms: Adult, Aged, Comorbidity, Diabetes Mellitus, Female, France, Humans, Logistic Models, Male, Medication Errors, Medication Reconciliation, Middle Aged, Multivariate Analysis, Patient Admission, Patient Discharge, Patient Safety, Pharmacists, Pharmacy Service, Hospital, Polypharmacy, Prospective Studies, Risk Factors