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      Errores de medicación en pacientes hospitalizados: una revisión sistemática Translated title: Medication errors in hospitalized patients: a systematic review

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          Abstract

          Resumen Objetivo: Describir los errores de la medicación y sus factores asociados, así como evaluar la calidad metodológica de los estudios disponibles. Método: Se realizó una revisión sistemática de la literatura en las bases de datos PubMed, Scielo, LILACS, Ebsco. Medes, Sietes, Dialnet y Science Direct, teniendo en cuenta las referencias bibliográficas encontradas entre 2010 y 2020, entre los meses de mayo y abril de 2020, utilizando la ecuación de búsqueda Errores de medicación and Pacientes AND Hospitalización, y sus equivalentes en inglés y portugués. Se seleccionaron los estudios a través de un cribado que inició con la lectura de títulos, resumen y texto completo y se realizó la valoración de la calidad metodológica y riesgo de sesgo de los estudios mediante la lectura crítica con la guía Ciapponi. Resultados: Se incluyeron en la revisión 23 artículos, 43,4% transversales y 39% prospectivos. Se evidenció que los errores de medicación se presentan en las diferentes etapas del proceso de atención del paciente, siendo más frecuentes en la etapa de prescripción y administración del mismo. Estos errores se asociaron a la sobrecarga laboral, el número de medicamentos recibidos, las enfermedades complejas de los pacientes, estancias hospitalarias prolongadas, medicación intravenosa y distracción. Conclusiones: Los errores están presentes en los procesos de medicación, principalmente en las fases de prescripción y medicación de los medicamentos, asociados en mayor medida a la sobrecarga laboral, el número de medicamentos y la presencia de enfermedades complejas.

          Translated abstract

          Abstract Objective: to describe the errors of the medication and its associated factors, as well as to evaluate the methodological quality of the available studies. Method: a systematic review of the literature was carried out in the PubMed, Scielo, LILACS, Ebsco databases. Medes, Sietes, Dialnet and Science Direct, considering the bibliographic references found between 2010 and 2020, between the months of May and April 2020 using the search equation Medication Errors and Patients AND Hospitalization and their equivalents in English and Portuguese. The studies were selected through a screening that began with the reading of titles, abstracts and full text, and the methodological quality and risk of bias of the studies were assessed by means of critical reading with the Ciapponi guide. Results: 23 articles were included in the review, 43.4% cross-sectional and 39% prospectives. It was evidenced that medication errors occur in the different stages of the patient care process, being more frequent in the prescription and administration stage. These errors were associated with work overload, the number of medications the patients receive, complex patient illnesses, prolonged hospital stays, intravenous medication, and distraction. Conclusions: medication errors are present in the medication processes, mainly in the prescription and medication phases of medications, associated to a greater extent with work overload, the number of medications and the presence of complex diseases.

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          Most cited references57

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          The incidence and nature of prescribing and medication administration errors in paediatric inpatients.

          To determine the incidence and nature of prescribing and medication administration errors in paediatric inpatients. Prospective review of drug charts to identify prescribing errors and prospective observation of nurses preparing and administering drugs to identify medication administration errors. In addition, incident reports were collected for each ward studied. Paediatric patients admitted to hospitals and nurses administering medications to these patients. 11 wards (prescribing errors) and 10 wards (medication administration errors) across five hospitals (one specialist children's teaching hospital, one nonteaching hospital and three teaching hospitals) in the London area (UK). Number, types and incidence of prescribing and medication administration errors, using practitioner-based definitions. 391 prescribing errors were identified, giving an overall prescribing error rate of 13.2% of medication orders (95% CI 12.0 to 14.5). There was great variation in prescribing error rates between wards. Incomplete prescriptions were the most common type of prescribing error, and dosing errors the third most common. 429 medication administration errors were identified; giving an overall incidence of 19.1% (95% CI 17.5% to 20.7%) erroneous administrations. Errors in drug preparation were the most common, followed by incorrect rates of intravenous administration. Prescribing and medication administration errors are not uncommon in paediatrics, partly as a result of the extra challenges in prescribing and administering medication to this patient group. The causes and extent of these errors need to be explored locally and improvement strategies pursued.
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            The impact of computerized physician medication order entry in hospitalized patients--a systematic review.

            To identify all published studies evaluating computerized physician order entry (CPOE) in the inpatient setting and uniformly classify these studies on outcome measure and study design. All studies that evaluated the effect of CPOE on outcomes pertaining to the medication process in inpatients were electronically searched in MEDLINE (1966 to August 2006), EMBASE (1980 to August 2006) and the Cochrane library. In addition, the bibliographies of retrieved articles were manually searched. Articles were selected if one of their main objectives was CPOE evaluation in an inpatient setting. Identified titles and abstracts were independently screened by three reviewers to determine eligibility for further review. We found 67 articles, which included articles on CPOE evaluation on some outcome at the time of ordering. Most papers evaluated multiple outcome measures. The outcome measures were clustered in the following categories: adherence (n=22); alerts and appropriateness of alerts (n=7); safety (n=21); time (n=7); costs and (organizational) efficiency (n=23); and satisfaction, usage and usability (n=10). Most studies used a before-after design (n=35) followed by observational studies (n=24) and randomized controlled trials (n=8). The impact of CPOE systems was especially positive in the category adherence to guidelines, but also to some extent in alerts and appropriateness of alerts; costs and organizational efficiency; and satisfaction and usability. Although on average, there seems to be a positive effect of CPOE on safety, studies tended to be non-randomized and were focused on medication error rates, not powered to detect a difference in adverse drug event rates. Some recent studies suggested that errors, adverse drug events (ADEs) and even mortality increased after CPOE implementation. Only in the category time the impact has been shown to be negative, but this only refers to the physician's time, not the net time. Except for safety, on the whole spectrum of outcomes, results of RCT studies were in line with non-RCT study results.
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              National burden of preventable adverse drug events associated with inpatient injectable medications: healthcare and medical professional liability costs.

              Harmful medication errors, or preventable adverse drug events (ADEs), are a prominent quality and cost issue in healthcare. Injectable medications are important therapeutic agents, but they are associated with a greater potential for serious harm than oral medications. The national burden of preventable ADEs associated with inpatient injectable medications and the associated medical professional liability (MPL) costs have not been previously described in the literature.
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                Author and article information

                Journal
                ars
                Ars Pharmaceutica (Internet)
                Ars Pharm
                Universidad de Granada (Granada, Granada, Spain )
                2340-9894
                June 2021
                : 62
                : 2
                : 203-218
                Affiliations
                [2] Cartagena Bolívar orgnameUniversidad de Cartagena orgdiv1Facultad de Medicina Colombia
                [1] Barranquilla Bolívar orgnameCorporación Universitaria Rafael Núñez orgdiv1Programa de Enfermería Colombia
                [4] Cartagena Bolívar orgnameUniversidad de Cartagena orgdiv1Facultad de Enfermería orgdiv2Grupo Cuidado a la Salud de los Colectivos Colombia
                [3] Cartagena Bolívar orgnameUniversidad del Sinú orgdiv1Escuela de Medicina Colombia
                Article
                S2340-98942021000200203 S2340-9894(21)06200200203
                10.30827/ars.v62i2.16166
                a7e74140-cf17-4901-aa55-c8ed31d245ed

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 24 January 2021
                : 16 October 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 57, Pages: 16
                Product

                SciELO Spain

                Categories
                Artículos de Revisión

                Medication errors,patients,Hospitalization,Errores de medicación,pacientes,Hospitalización

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