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Received: 20 January 2020
Revised: 9 April 2020
Accepted: 10 April 2020
DOI: 10.1111/jep.13407
ORIGINAL PAPER
Intervention study for the reduction of medication errors in
elderly trauma patients
María de los Angeles
Parro Martín Hospital Pharmacy Specialist1
|
María Muñoz García Doctor of Pharmacy, Hospital Pharmacy Specialist1
|
Eva Delgado Silveira Doctor of Pharmacy, Hospital Pharmacy Specialist1 |
Sagrario Martín-Aragón Alvarez
Doctor of Pharmacy, Professor2 |
Teresa Bermejo Vicedo Doctor of Pharmacy, Hospital Pharmacy Specialist1
1
Servicio de Farmacia, Hospital Universitario
Ramón y Cajal, Madrid, Spain
2
Departamento de Farmacología,
Farmacognosia y Botánica, Facultad de
Farmacia, Universidad Complutense, Madrid,
Spain
Correspondence
M. Angeles
Parro Martín, Servicio de Farmacia,
Hospital Universitario Ramón y Cajal, 28034
Madrid, Spain.
Email: [email protected]
Abstract
Objective: To analyse the impact of a set of measures designed by a working group
to reduce medication errors (MEs) during the care transition of elderly trauma
patients. The secondary objectives were to classify MEs and determine their location.
Methods: A 43-month pre-post prospective intervention study in a university hospital. A working group was set up in the Trauma Service. A pharmacist analysed the
pharmacotherapeutic processes of all patients admitted to the Trauma Service in different healthcare locations from Monday to Friday. To detect MEs, the pharmacist
reviewed this process at the following points: reconciliation, prescription, validation,
dispensing, and administration records. Errors were classified according to the Ruiz
Jarabo classification. Subsequently, the working group designed a set of measures
that were implemented with the incorporation into the Acute Care Team and the
intervention of a pharmacist. Data on MEs were again collected in a postimplementation phase.
Results: There was a statistically significant reduction in MEs between phases. A total
of 132 (31.3%) patients experienced MEs during the pre-implementation phase and
75 (16.2%) during the post-implementation phase. Among the measures
implemented, the incorporation of the pharmacist to the team, as well as training sessions and design of medication protocols. During the pre-implementation and postimplementation phases, the ME rates were respectively as follows: reconciliation
31.6% (172) vs 14.8% (91); prescription 7.7% (79) vs 1.9% (23); dispensing 1% (10) vs
0.3% (3); administration record 0.4% (4) vs 0.0% (0); and validation 0.3% (3) vs 0.1%
(1). There were significant reductions in reconciliation, prescription, and dispensing
errors. The majority of the MEs occurred in the Trauma Service.
Conclusions: The implementation of specific measures by a Multidisciplinary Safety
Group reduced MEs in the care transition of elderly trauma patients, particularly
those MEs that occurred during reconciliation. The greatest reduction in MEs
occurred in the Trauma Service.
160
© 2020 John Wiley & Sons, Ltd.
wileyonlinelibrary.com/journal/jep
J Eval Clin Pract. 2021;27:160–166.
161
PARRO MARTÍN ET AL.
KEYWORDS
medication error, pharmaceutical care, pharmaceutical intervention, safety group,
traumatology
1
|
I N T RO DU CT I O N
2
|
MATERIAL AND METHOD
Medication errors (MEs) are the most frequent cause of adverse
A 43-month pre-post intervention study (April 2015-November 2018)
events, which result in patient injury and even death, and involve sig-
conducted in a university hospital.
nificant health costs. There are no error-free systems and therefore
The MHSG was formed by different representatives of the
the fundamental objective of clinical safety is to minimize the risks
Traumatology, Anaesthesia, Geriatrics, and Pharmacy Services. The
and likelihood of errors, thereby enabling processes to be conducted
group comprised one traumatologist, one geriatrician, two anaesthetists,
correctly.1
three pharmacists, two nursing supervisors (traumatology and orthog-
The retrospective ENEAS study conducted with 5624 patients
eriatrics), and one nurse. At the first official meeting of the group (April
admitted to 24 Spanish public hospitals. It found that of the total
2015) it was decided to hold meetings on a monthly basis. One of the
number of adverse events, 37.4% were related to medication. Of
objectives of this group was to define strategies to prevent MEs in the
these, 34.8% were avoidable.2 Several Spanish studies have found a
hospital. Thus, we had to determine the real situation of patients and
prevalence of MEs of between 7% and 22%, suggesting that they are
their treatment during the different care transitions in order to be able
a highly relevant problem, particularly because almost 50% of them
to define and implement measures to improve the safety of the entire
are preventable.3 In recent years, initiatives have been developed to
pharmacotherapeutic process.
improve patient safety in Spain by the Ministry of Health, Social Services and Equality, Autonomous Communities, scientific societies, and
other institutions.4 However, as is the case of the United States and
other countries, the degree of implementation in Spain remains low.5
2.1 | Sample size and locations in patient care
transition
The recommendations of the Quality Plan of the National Health System and the World Health Organization (WHO) include the creation
For the calculation of the sample size, expressed as lines of treatment
of Multidisciplinary Working Groups within each specialty.6 The active
to evaluation, the prevalence of reconciliation errors of 50% calcu-
involvement of the pharmacist within these groups is crucial to
lated in a previous study carried out in our centre will be considered
improve the safety of all the processes in medication use systems.4
as a reference value.12 The sample size calculation was made
The benefits of pharmaceutical intervention have been verified in dif-
accepting an alpha risk of 0.05 and a beta risk of 0.20 in a bilateral
ferent studies, which have demonstrated acceptance rates of 39.0%
contrast. Taking into account 10% losses, the number of treatment
to 91.6% in relation to prescribers accepting the pharmacists’ recom-
lines required to detect a difference ≥0.025 at each point in the pro-
mendations.7 A review of 36 studies analysing the impact of pharma-
cess was 427, assuming that the prevalence of errors after the imple-
cists’ activity on hospitalized patients has suggested that their
mentation of improvement measures could decrease to 40%.
incorporation into the Acute Care Team resulted in improved care
with no evidence of harm.8,9
The GSMH decided the locations and points of the process
according to the errors detected.
The implementation of prevention strategies can be facilitated by
The MHSG decided to analyse three locations during patient
determining at which points in the medication use process the highest
care transition: the Emergency Department (ED), the Reanimation
rates of MEs occur. The WHO has established effective AE preven-
and Post-Anaesthesia Unit (RPAU), and the Traumatology Hospitali-
tion measures, such as medication reconciliation in care transitions.10
zation Unit. In addition, we decided to assess the medication use
In addition, it has been estimated that 50% of surgical patients
process at the following points: reconciliation, prescription, valida-
11
This aspect, together with
tion, dispensing, and administration records. All MEs were analysed if
the great complexity and severity of patients treated in Orthopaedic
their rate was more than 2% at each point of use. The sample size
Surgery and Trauma Services, has led to a significant increase in
was obtained based on a study conducted previously in the same
adverse events, many of which are very severe.1 In order to analyse
centre.
take some type of chronic medication.
these adverse events and reduce MEs, we decided to create a Multidisciplinary Safety Group in the Trauma Service of our hospital.
The main objective of this study is to analyse the impact of a set
of measures designed by a Multidisciplinary Hospital Safety Group
2.2 | Medical errors according to the process
analysed
(MHSG) to reduce MEs during the care transition of elderly trauma
patients. The secondary objectives are to classify errors and deter-
All the patients admitted to the Traumatology Service were selected.
mine their location.
Patients admitted to other Services were excluded.
162
PARRO MARTÍN ET AL.
In the pre-implementation phase, the pharmacist reviewed all the
The types of RE, PE, and VE were classified according to the Ruiz
pharmacotherapeutic processes of patients admitted to the Trauma
Jarabo classification.13 The errors at the various points in the process
Service. The data were collected according to the different locations
were analysed independently, so that an error detected in one process
and points of the process. The dependent variable was ME. The MEs
could not influence the subsequent analysis of another process.
were classified according to the process in which they occurred:
The independent variables were the age and sex of the selected
patients.
• Reconciliation
the
The pharmacist in charge prepared a report on the errors found in
pharmacotherapeutic history to detect REs. Thus, the patient or
the pre-implementation phase, which were classified according to the
family member/caregiver was interviewed to obtain data on
point of the process and the location in which they occurred.
error
(RE):
the
pharmacist
prepared
chronic medication and compared this data with the medications
The results of the pre-implementation phase were analysed over
prescribed by the doctor. In addition, the pharmacist reviewed
the course of several meetings by the MHSG, which drew up a set of
the Primary Care viewer (HORUS) and the Specialized Care clini-
measures to be implemented in a subsequent phase.
cal reports (CAJAL). Any discrepancy not justified by the doctor
After the implementation of the measures and a 3-month wash-
was considered to be an RE. The prevalence of REs was calcu-
out period, we repeated the systematic data collection process
lated by dividing the number of REs by the total number of lines
described above (post-implementation phase).
In July 2015, approval for the study was obtained from the hospi-
of reconciled medicines.
• Prescribing error (PE): the pharmacist reviewed the treatment pre-
tal’s Drug Research Ethics Committee.
scribed by the doctor using the Electronic Assisted Prescribing program for the selected patients. A failure in the prescribing process
that resulted in an incorrect instruction about one or more of the
3
|
RE SU LT S
regular features of a prescription was considered to be a
PE. Regular characteristics included appropriate medication (with
We reviewed the data of 886 patients, of whom 207 (23.4%) had
correct indication, duration, and without contraindications or rele-
experienced ME. We also analysed 9976 medication lines. The mean
vant interactions), dose, frequency, and route of administration.
age of patients who had experienced ME (60.4% women) was 79.5
The prevalence of PEs was calculated by dividing PEs by the total
± 14 years.
number of lines of prescribed medicines.
In the pre- and post-implementation phases, 31.3% (132) and
• Validation error (VE): a review was conducted of the validation
16.2% (75) of patients had experienced an ME, respectively. After the
process of the treatments prescribed using the Electronic Assisted
agreed measures had been implemented, there was a decrease in MEs
Prescribing for the selected patients. Cases in which the prescrip-
from 5.7% to 2.2% (P < .001).
tion, dose, frequency, and route of administration of a medicine
After the results of the pre-implementation phase had been
were not appropriate and which had not been corrected by a phar-
analysed, the MHSG proposed the following improvement measures:
macist during the validation process were considered to be VEs.
The prevalence of VEs was calculated by dividing the number of
VEs by the total number of lines of validated medicines.
• Dispensing error (DE): over a period of 1 week, the pharmacist
determined whether the prescribed and validated medication had
been dispensed correctly. Thus, the pharmacist reviewed the contents of the boxes of the medication unit dose trolley from the
Trauma Service prepared by the Auxiliary Nursing Care Technicians (ANCT) of the Pharmacy Service. Any discrepancy between
the drug prescription (type, quantity, and dose) and the medicine
1. The incorporation of a pharmacist in the multidisciplinary team
during the medication reconciliation process at the time of admitting the patients to the ED and the Traumatology Unit.
2. The review and dissemination of the medication reconciliation process at hospital admission and discharge.
3. The implementation of a training session in the Trauma Service for
doctors and the ANCTs of the Pharmacy Service.
4. The addition of protocols and alerts to the Electronic Assisted Prescribing program.
that the ANCT had placed in the patients' boxes was considered to
be a DE. In addition, a review was conducted of the medication
Tables 1 and 2 summarize the medication lines, MEs, and percent-
replenishment of the Emergency Department's (ED) automatic dis-
age of MEs by location and point of use, indicating the most frequent
pensing system. The prevalence of DE was calculated by dividing
type of error at each point.
the number of DEs by the total number of medicines dispensed.
In the post-implementation phase, there was a 50% decrease in
• Administration record error (ARE): the pharmacist reviewed all
REs (P < .001). In total, 68.1% (62) of the recommendations made by
administration record sheets completed by the nursing staff from
the pharmacist were accepted. In addition, the number of REs
Monday to Friday. Any discrepancy (type, dose, time) between the
decreased by 57.2% and 27.7% in the Traumatology Unit and the ED,
administration records and interviews with the nurses in charge of
respectively. There were striking improvements in the type of RE
the patients were considered to be AREs. The prevalence of AREs
“omission of a medicine.”
was calculated by dividing the number of AREs by the total number
of medicines administered.
In the post-implementation phase, there was a 75.3% decrease
in PEs (P < .001). There were decreases of 83.3% in the ED,
163
PARRO MARTÍN ET AL.
TABLE 1
Number of MEs by location and point of use of the medication process
Number
of lines with
Total number
MEs in the
of lines revised
in the PRE phase PRE phase
% of
MEs in Most frequent type
the PRE of ME in the PRE
phase
phase
Total number
of lines
revised
in the POST
phase
Number
of lines with
MEs in the
POST phase
% of MEs
in the
POST
Most frequent type of
phase
ME in the POST phase
Reconciliation
Emergency
119
department
24
20.2
Omission of a
medication (58.3%)
184
27
14.6
Omission of a medication
(74.1%)
Trauma unit
425
148
34.8
Omission of a
medication (79.1%)
430
64
14.9
Omission of a medication
(67.2%)
Total RE
544
172
31.6
Omission of a
medication (76.2%)
614
91
14.8
Omission of a medication
(69.2%)
Emergency
162
department
12
7.4
Incorrect
administration,
frequency (33.3%)
331
2
0.6
Incorrect pharmaceutical
form (100.0%)
RPAU
433
37
8.6
Incorrect
administration,
frequency (54.1%)
444
12
2.7
Incorrect treatment
duration: longer
duration (58.3%)
Trauma unit
431
30
7.0
Incorrect
administration,
frequency (46.7%)
451
9
1.9
Others: indication in
remarks undated
(88.9%)
Total PE
1026
79
7.7
Incorrect
administration,
frequency (48.1%)
1226
23
1.9
Others: indication in
remarks undated
(34.8%)
Prescription
Abbreviations: MEs, medication errors; PE, prescription errors; POST, post-implementation; PRE, pre-implementation; RE, reconciliation errors; RPAU,
Reanimation and Post-Anaesthesia Unit.
70.0% in the Traumatology Unit, and 67.6% in the RPAU. We
use of different MEs in the studies, as well as the use of different defi-
draw attention to the marked improvements in the type of PE
nitions, scenarios, and methodologies.15
“frequency of incorrect administration” in the RPAU and the
Traumatology Unit.
The following discussion addresses each point of use of the medication process affected by MEs.
In the pre-implementation phase, the number of DEs, VEs, and
AREs detected was less than 2%. In the post-implementation phase,
there was a statistically significant decrease in DEs, but not in VEs
4.1
|
Reconciliation
or AREs.
One of the implemented measures was the incorporation of the
pharmacist within the multidisciplinary team in the reconciliation
4
|
DISCUSSION
process during patient admission. A systematic review by Cheema
et al16 found an association between active interventions by phar-
Strategic plans to improve patient safety include the creation of Multi-
macists such as medication reconciliation, personalized patient
disciplinary Safety Groups. Although there is an increasing number of
counselling, and the provision of telephone consultations to deliver
studies on such groups, no data are available concerning their direct
patient care after hospital discharge and a reduction in medication
results.6 The present study showed that the incorporation of an
discrepancies compared to standard care.
MHSG in the Trauma Service led to a statistically significant reduction
The most frequent errors were REs. They comprised 68.1% of
in MEs from 5.7% to 2.2%. In addition, the number of patients who
the total MEs analysed (pre- and post-implementation phases), underwent
had experienced MEs decreased from 31.3% to 16.2%. This interven-
a statistically significant 50% decrease after the implementation of
tion was widely accepted by the traumatology service and by the cen-
the measures. In addition, 68.1% of the recommendations made by the
tre, actively participating in the objective of said intervention.
pharmacist were accepted. Franco et al17 and Pascual et al18 found
It is currently estimated that the prevalence of MEs ranges from
14
discrepancies in medication reconciliation ranging from 42.0% to
Although several studies have documented the inci-
48.0% of trauma patients. However, Moriel et al19 found higher values in
dence of adverse events and MEs in Trauma Services, there were vari-
trauma patients (71.4%). These results are similar to those found in the
ations in the reported frequencies.1,14 These variations are due to the
present study (75.9%). The difference between our results and those of
2% to 75%.
164
PARRO MARTÍN ET AL.
TABLE 2
Number of MEs by location and point of use of the medication process
Total number
of lines revised
in the PRE phase
Number
of lines
with MEs
in the PRE
phase
% of
MEs in
the PRE
phase
Most frequent type of ME
in the PRE phase
Total
number
of lines
revised in
the POST
phase
Number
of lines
with MEs
in the
POST
phase
% of
MEs in
the POST
phase
Most frequent type of
ME in the POST phase
Validation
Emergency
department
207
0
0.0
NA
217
1
0.50
Incorrect
pharmaceutical form
(100.0%)
RPAU
435
2
0.5
Incorrect pharmaceutical
form (100.0%)
434
0
0.0
NA
Trauma unit
438
1
0.2
Incorrect pharmaceutical
form (100.0%)
427
0
0.0
NA
Total VE
1080
3
0.3
Incorrect pharmaceutical
form (100.0%)
1078
1
0.1
Incorrect
pharmaceutical form
(100.0%)
Dispensing
Trauma unit
449
8
1.8
Omission of a medication
(100.0%)
571
0
0.0
NA
Emergency
department
628
2
0.3
Omission of a medication
(50.0%) and Others: a
medication that is not
prescribed appears in the
box (50.0%)
530
3
0.5
Others: a medication
that is not prescribed
appears in the box
(66.6%)
Total DE
1077
10
1.0
Omission of a medication
(60.0%)
1101
3
0.3
Others: a medication
that is not prescribed
appears in the box
(66.6%)
Administration
record
Emergency
department
215
0
0.0
NA
287
0
0.0
NA
RPAU
267
4
1.5
The administration record
sheet is not signed by
the nurse in charge
(100.0%)
435
0
0.0
NA
Trauma unit
501
0
0.0
NA
525
0
0.0
NA
The administration record
sheet is not signed by
the nurse in charge
(100.0%)
1247
0
0.0
NA
Total ARE
983
4
0.4
Abbreviations: ARE, administration record errors; DE, dispensing errors; MEs, medication errors; NA, not applicable; PRE, pre-implementation; POST,
post-implementation; RPAU, Reanimation and Post-Anaesthesia Unit; VE, validation errors.
other authors may be due to the higher mean age of the population in the
unable to find any studies that have analysed MEs in different loca-
present study.
tions during care transition.
The most common type of RE was “medication omission.”
This result is similar to those obtained in studies conducted
in an Internal Medicine Service20,21 and in an Intermediate Care
4.2
|
Prescription
Service.22 These studies found “medication omission” rates
of 60.0%.
One of the improvement measures implemented by the MHSG was to
Regarding location, after the implementation of measures in the
improve prescriber training. Several authors have shown an associa-
Emergency Department, RE rate was 14.6%, which was similar to that
tion between training in the prescription of specific medicines and
observed in the Traumatology Unit (14.9%). To date, we have been
decreases in PEs.23,24 In addition, two of the improvement measures
165
PARRO MARTÍN ET AL.
were related to the Electronic Assisted Prescribing program: the
prevalence of DEs of between 1.0% and 2.2%.29,31 These results are
incorporation in the program of guidelines on the prescription of spe-
similar to those found in the present study.
cific medicines and on groups of patients; and the creation of new
In the pre-implementation phase, the most frequent type of DE
pharmacotherapeutic protocols. Several studies have shown an asso-
was “omission of medication,” whereas in the post-implementation
ciation between prescription guidelines and decreases in PEs.25,26
phase it was “Others: a medication that is not prescribed appears in
The implementation of these measures led to a significant reduction
the box.” The literature suggests that the three most frequent types
of DE are “omission,” “different amount of medicines in the dispensing
in PEs from 7.7% to 1.9%.
Vélez Díaz Pallarés et al27 reported PE rates of 9.1% in trauma
box” and “different dosage of the medicinal product.”30,31
patients, while García-Ramos et al28 found PE rates of 10.1% in internal medicine patients. Both these rates are similar to those found in
4.5
the present study.
|
Administration record
In the pre-implementation phase, the most frequent type of PE
was “incorrect administration frequency,” which was practically elimi-
The majority of published studies have analysed administration errors
nated in the post-implementation phase. This result was thought to
by use of the direct observation method (ie, the presence of an
be due to the implementation of protocols in the Electronic Assisted
observer at the time of administration).31 However, we checked that
Prescribing program, which includes frequency of administration.
the medication administration record was correct and unambiguous
Vélez et al27 found that “incorrect dose” is the most frequent PE
after each shift of medication administration. We were unable to find
followed by “incorrect frequency” in trauma patients, while García-
any study that exclusively addressed administration records, with the
found that the most frequent PE is “incorrect dose” in
exception of the study by Vicente et al32. These authors found an
28
Ramos et al
internal medicine patients.
ARE rate of 48.0%, which is a very high percentage in comparison to
Regarding location, after the implementation of measures, there
was a 2.7% decrease in PEs in the RPAU, a 1.9% decrease in the
the rate we observed. This difference is probably due to the use of
different methodologies.32
Traumatology Unit, and a 0.6% decrease in the ED. After the measures
One of the limitations of the present study is related to the use of
were implemented, there were similar decreases in PEs in all locations
the pre-post research method. Thus, we cannot ensure that the
of care transition with values ranging between 70.0% and 80.0%.
changes observed were due to the intervention itself or to uncontrolled factors. In addition, the pre- and post-intervention samples are
not strictly comparable due to the fact that they were obtained at
4.3
|
Validation
different times of the year (pre: June-October 2016; post: JanuaryApril 2018) and that different health professionals conducted the
Delgado et al29 used the same Electronic Assisted Prescribing soft-
healthcare activities. Therefore, the results may have been influenced
ware used in the present study. These authors found a prevalence of
by these factors.
VEs of 0.1%, which is similar to the results of both phases of the pre-
Despite these limitations, we suggest that the incorporation of
sent study (ie, 0.3% and 0.1%, respectively).29 Other authors have
the MHSG in the Trauma Service of our hospital improved the safety
found prevalences of between 2.0% and 27.0%: however, some stud-
of patients admitted to this service, given that there was a striking
30
It is difficult to
decrease in the number of MEs at all points in the medication process
compare the prevalence of VEs, depending on the methodology, asso-
analysed. This intervention has been well accepted by the centre, in
ciate the validation and transcription errors, or those of prescription
fact the GSMH is still active today and is one of the most important
and validation. Furthermore, almost none of these studies included
error notification routes. The incorporation of the pharmacist in the
15,29,31
multidisciplinary team was shown to be an effective measure in the
ies have found that VEs comprise 10.0% of all MEs.
definitions of the types of error.
The only type of VE we observed was “wrong pharmaceutical
reduction of REs at hospital admission.
form.” Pastó Cardona et al31 found that the most frequent type of
VE is “omission” followed by “wrong dose.” Vélez et al15 reported
OR CID
similar results. Differences in the types of VE observed are due to
María de los Angeles
Parro Martín
the way in which the processes were defined, leading to them being
8841-9364
https://orcid.org/0000-0001-
classified in different ways.
RE FE RE NCE S
4.4
|
Dispensing
The percentage of DEs was low because several of the measures to
reduce DEs described in the literature had already been implemented
in our hospital. These DEs comprised 3.4% of all MEs analysed (preand post-implementation phase). Several studies have shown a
1. Grau J, Santiñá M, Combalia A, Prat A, Suso S, Trilla A. Fundamentos
de seguridad clínica en cirugía ortopédica y traumatología. Rev Esp Cir
Ortop Traumatol. 2010;4:251-258.
2. Ministerio de Sanidad y Consumo;. Estudio nacional sobre los efectos
adversos ligados a la hospitalización: ENEAS 2005; 2006.
3. Guerro-Prado M, Olmo-Revuelto MA, Catalá-Pindado M. Prevalence
of medication-related problems in complex chronic patients and
opportunities for improvement. Farm Hosp. 2018;42(5):197-199.
166
4. Otero López MJ. El papel del farmacéutico en la gestión de la
seguridad de los medicamentos diez años después de la publicación
del informe “Errar es Humano”. Farm Hosp. 2010;34(4):159-162.
5. Ministerio de Sanidad y Consumo. Estudio de evaluación de la
seguridad de los sistemas de utilización de los medicamentos en los
hospitales españoles (2007). Informe Mayo 2008; 2007.
6. Vargas M, Recio M. Versión española de University of Michigan
Health System Patient Safety Toolkit. Mejorando la seguridad del
paciente en los hospitales: de las ideas a la acción. Traducción de
2008; 2008.
7. Muñoz GM. Criterios stopp/start versus criterios de beers, aplicación en
diferentes unidades de hospitalización. Madrid, Spain: Universidad
Complutense de Madrid; 2013.
8. Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinical pharmacists
and inpatient medical care: a systematic review. Arch Intern med.
2006;166(9):955-964.
9. Jacobi J. Farmacéuticos clínicos: profesionales esenciales del equipo
de atención clínica. Rev Med Clin Condes. 2016;5:578-584.
10. World Health Organization, Safety. WAFP. Patient Safety Solutions;
2007.
11. Gobierno de Cantabria. Consejería de Sanidad y Servicio Sociales.
Manual de seguridad del paciente quirúrgico. Servicio Cántabro de
Salud; 2014.
12. Rodríguez Vargas B. Conciliación de la medicación al ingreso
hospitalario. Tesis Doctoral. Universidad Complutense de Madrid; 2014.
13. Otero López MJ, Castaño Rodríguez B, Pérez Encinas M, et al.
Updated classification for medication errors by the Ruiz-Jarabo 2000
group. Farm Hosp. 2008;32(1):38-52.
14. Lisby M, Nielsen LP, Brock B, Mainz J. How are medication errors
defined? A systematic literature review of definitions and characteristics. International J Qual Health Care. 2010;22(6):507-518.
15. Vélez-Díaz PM. Análisis modal de fallos y efectos en el proceso de prescripción, validación y dispensación de medicamentos. Madrid, Spain:
Universidad Complutense de Madrid; 2012.
16. Cheema E, Alhomoud FK, Kinsara ASA, et al. The impact of
pharmacists-led medicines reconciliation on healthcare outcomes in
secondary care: a systematic review and meta-analysis of randomized
controlled trials. PLoS One. 2018;13(3):e0193510.
17. Franco-Donat M, Soler-Company E, Valverde-Mordt C, GarcíaMuñoz S, Rocher-Milla A, SangÜesa-Nebot MJ. Conciliación de la
medicación al ingreso y al alta hospitalaria en un servicio de cirugía
ortopédica y traumatológica. Rev Esp Cir Ortop Traumatol. 2010;54(3):
149-155.
18. Pascual O, Real JM, Uriarte M, Larrodé I, Alonso YM, Abad MR. Evaluation of medication reconcilliation in a trauma unit. Rev Esp Cir Ortop
Traumatol. 2015;59(2):91-96.
19. Moriel MC, Pardo J, Catalá RM, Segura M. Prospective study on conciliation of medication in orthopaedic patients. Farm Hosp. 2008;32
(2):65-70.
20. Pippins JR, Gandhi TK, Hamann C, et al. Classifying and predicting
errors of inpatient medication reconciliation. J Gen Intern med. 2008;
23(9):1414-1422.
PARRO MARTÍN ET AL.
21. Belda-Rustarazo S, Cantero-Hinojosa J, Salmeron-García A, GonzálezGarcía L, Cabeza-Barrera J, Galvez J. Medication reconciliation at
admission and discharge: an analysis of prevalence and associated risk
factors. Int J Clin Pract. 2015;69(11):1268-1274.
22. Lessard S, DeYoung J, Vazzana N. Medication discrepancies affecting
senior patients at hospital admission. Am J Health Syst Pharm. 2006;
63(8):740-743.
23. Daumas A, Garros E, Mendizabal H, et al. Impact of an evaluation of the
professional practices on the relevance of proton pump inhibitors prescriptions pertinence at the hospital. Rev Med Interne. 2018;39(8):618-626.
24. Navaneethan S, Venkatesh S, Nannapaneni S, Shrivastava R. Educational intervention: a tool for decreasing medication errors. International J Qual Health Care. 2005;17(1):83.
25. Shulman R, Singer M, Goldstone J, Bellingan G. Medication errors: a
prospective cohort study of hand-written and computerised physician
order entry in the intensive care unit. Crit Care. 2005;9(5):R516R521.
26. Eslami S, de Keizer NF, Abu-Hanna A. The impact of computerized
physician medication order entry in hospitalized patients - a systematic review. Int J med Inform. 2008;77(6):365-376.
27. Vélez-Díaz Pallarés M, Delgado Silveira E, Pérez Menéndez-Conde C,
Bermejo VT. Análisis de errores de la prescripción manual comparados con la prescripción electrónica asistida en pacientes
traumatológicos. Farm Hosp. 2011;35(3):135-139.
28. García-Ramos SE, Baldominos Utrilla G, Herrero Fernandez M,
Lebrero GA. Detection of prescription errors associated with an electronic prescription system. Farm Hosp. 2012;36(5):439-440.
29. Delgado Sánchez O, Escrivá Torralva Vilanova Boltó M. Estudio comparativo de errores con prescripción electrónica versus prescripción
manual. Farm Hosp. 2005;29:228-235.
30. Climent C, Font-Noguera I, Poveda Andrés JL, López Briz E, Peiró S.
Errores de medicación en un hospital terciario con tres sistemas de
distribución de medicamentos diferentes. Farm Hosp. 2008;32(1):
18-24.
31. Pastó-Cardona L, Masuet-Aumatell C, Bara-Oliván B, et al. Estudio de
incidencia de los errores de medicación en los procesos de utilización
del medicamento: prescripción, transcripción, validación, preparación,
dispensación y administración en el ámbito hospitalario. Farm Hosp.
2009;33(5):257-268.
32. Vicente ON. Evaluación de la seguridad de un programa informático
para el registro de la administración de medicamentos en el ámbito
hospitalario. Madrid, Spain: Universidad Complutense; 2017.
Muñoz García M,
How to cite this article: Parro Martín MA,
Delgado Silveira E, Martín-Aragón Alvarez S, Bermejo
Vicedo T. Intervention study for the reduction of medication
errors in elderly trauma patients. J
