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

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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“…Однако на практике нередко в стационаре заменяют схему базисной терапии, подобранной пациенту ранее, так же как на амбулаторном этапе не придерживаются рекомендаций врачей стационара. Показано, что при поступлении в стационар для планового хирургического вмешательства в 70% случаев отмечалось изменение постоянной терапии сердечнососудистых, бронхолегочных, эндокринологических заболеваний, что могло привести к их обострениям или декомпенсации [9].…”