Jianghua
Asia-Pacific Medical Frontiers.
2025, 1(2):
39-54.
Objective This study aims to investigate the preventive effect of pharmacist-led medication reconciliation services on medication error deviations in endocrine patients, through in-depth analysis of medication reconciliation implementation for endocrine patients. Methods Based on WHO's High 5S standard operating procedures and guidelines for medication reconciliation, a practical process was developed. Adult inpatients in the Endocrinology Department of the Second Hospital of Shanxi Medical University from January to December 2024 were selected for practice exploration. Patient information was collected, categorized, and summarized. Medication discrepancies between BPMH and medical orders were identified and classified as intentional or unintentional. The potential harm of unintentional discrepancies was evaluated. SPSS was used for multivariate logistic regression analysis to determine the correlation between patients' general conditions, clinical characteristics, and unintentional medication discrepancies. Results This study systematically analyzed drug reconciliation data of 354 endocrinology inpatients. The mean age was 59.46±11.85 years, with 85.03% having diabetes as the main diagnosis. Patients had an average of 7.18±3.23 co-diagnoses and 3.96±2.78 medications in BPMH, 56.78% of which were from verbal reports with medication packages. The maximum number of medications per patient was 14. Results showed 85 patients had unintentional medication discrepancies (UMD). Missed doses, delayed discontinuation, and overlooked administrations were the most common UMD types, accounting for 56.57%, 18.86%, and 12.57% respectively, with Level 1 being the main potential harm. ATC coding indicated digestive/metabolic, cardiovascular, and blood/hematopoietic drugs were the top three drug classes involved in UMD, at 44.00%, 26.86%, and 8.00%. Physician experience, BPMH medication count and data source significantly affected UMD occurrence. Conclusion Analysis of medication reconciliation data from 354 endocrinology inpatients revealed the widespread presence of unintentional medication discrepancies (UMD), with the most common issue being missed doses, and potential harms primarily classified as Category 1. The medications involved mainly fell under categories such as alimentary tract and metabolism, and cardiovascular system, which correlates with patients' multimorbidity and complex medication regimens. This study confirmed that the number of Best Possible Medication Histories, their sources, and admitting physician involvement were all associated with increased UMD risk. To mitigate UMD risks and ensure medication safety, standardized medication reconciliation processes must be established, multidisciplinary collaboration strengthened, clinical pharmacists' expertise leveraged, information collection optimized, and targeted interventions developed based on influencing factors. These findings may also serve as a reference for other departments and healthcare institutions.