입원 시 지참약의 안전관리
Effects of Medication Reconciliation System on Patient Safety Management
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초록
Unintended medication discrepancies in the prescription are responsible for multiple medication errors such as omissions, duplications, dosing errors, or drug interactions at the time of hospital admission. These errors can increase clinical risks to patients. In order to reinforce the importance of medication management in clinical practice and for the addition of 'Medication Reconciliation' to the guideline for Medical Institution Assessment by KHIDI(Korea Health Industry Development Institute), Samsung Medical Center(SMC) developed the medication reconciliation system to manage patient’s safety. The objective of this study is to review and evaluate the effectiveness of the new system in reducing medication errors. In this retrospective study medical source records of patients who were admitted to SMC from January 1st in 2008 to August 31st in 2009 were analyzed in two groups i.e .before(January 1st to July 20th in 2008) and after(July 21st in 2008 to August 31st in 2009) the introduction of this new system. After the system was introduced, total number of medication reconciliation increased up to 200% compared to the period before the introduction of the system. Screening of the inpatient’s medication history through the system led to an increase in the rate of well-managed medications without duplication in up to 66% compared to 53% seen in the previous period. At the time of discharge, the rate was 75% and 66%, respectively. Linking the medication reconciliation system with DUR(Drug Utilization Review) system for 11 month(October, 2008 to August, 2009) resulted in detection of total 99 cases of inappropriate prescriptions. Total 81 cases were detected as drug-drug interaction and physicians were alerted at the time of prescriptions entries in the newly installed system. Among the observed drug-drug interactions, 33 cases were based on the notification of MIHWAF(the Ministry of Health, Welfare and Family Affairs) and 48 cases as per the rules of SMC. The rates of physicians' switching drugs after getting alerts of detected drug-drug interactions were 100% and 38%, respectively. Another 18 cases where duplication of drugs in the same therapeutic category was also observed, 33% of them were modified after notification. This study confirmed that application of the medication reconciliation system could contribute substantially for reduction in the medication errors and it can act as an important tool in improving patients' safety. Further research is requires to evaluate and establish the role of pharmacists in managing and enhancing the medication reconciliation system.
Abstract
Unintended medication discrepancies in the prescription are responsible for multiple medication errors such as omissions, duplications, dosing errors, or drug interactions at the time of hospital admission. These errors can increase clinical risks to patients. In order to reinforce the importance of medication management in clinical practice and for the addition of 'Medication Reconciliation' to the guideline for Medical Institution Assessment by KHIDI(Korea Health Industry Development Institute), Samsung Medical Center(SMC) developed the medication reconciliation system to manage patient’s safety. The objective of this study is to review and evaluate the effectiveness of the new system in reducing medication errors. In this retrospective study medical source records of patients who were admitted to SMC from January 1st in 2008 to August 31st in 2009 were analyzed in two groups i.e .before(January 1st to July 20th in 2008) and after(July 21st in 2008 to August 31st in 2009) the introduction of this new system. After the system was introduced, total number of medication reconciliation increased up to 200% compared to the period before the introduction of the system. Screening of the inpatient’s medication history through the system led to an increase in the rate of well-managed medications without duplication in up to 66% compared to 53% seen in the previous period. At the time of discharge, the rate was 75% and 66%, respectively. Linking the medication reconciliation system with DUR(Drug Utilization Review) system for 11 month(October, 2008 to August, 2009) resulted in detection of total 99 cases of inappropriate prescriptions. Total 81 cases were detected as drug-drug interaction and physicians were alerted at the time of prescriptions entries in the newly installed system. Among the observed drug-drug interactions, 33 cases were based on the notification of MIHWAF(the Ministry of Health, Welfare and Family Affairs) and 48 cases as per the rules of SMC. The rates of physicians' switching drugs after getting alerts of detected drug-drug interactions were 100% and 38%, respectively. Another 18 cases where duplication of drugs in the same therapeutic category was also observed, 33% of them were modified after notification. This study confirmed that application of the medication reconciliation system could contribute substantially for reduction in the medication errors and it can act as an important tool in improving patients' safety. Further research is requires to evaluate and establish the role of pharmacists in managing and enhancing the medication reconciliation system.
참고문헌 (21)
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