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BACKGROUND AND OBJECTIVE: To assess the impact of a software application to improve the quality of information concerning current patient medications and changes on the discharge report after hospitalization. To analyze the incidence of errors and to classify them. MATERIAL AND METHOD DESIGN: Quasi-experimental pre / post study with non-equivalent control group study. STUDY POPULATION: Medical patients at hospital discharge. INTERVENTION: implementation of a software application. VARIABLES: Percentage of reconciled patient medication on discharge, and percentage of patients with more than one unjustified discrepancy. RESULTS: A total of 349 patients were assessed; 199 (pre-intervention phase) and 150 (post-intervention phase). Before the implementation of the application in 157 patients (78.8%) medication reconciliation had been completed; finding reconciliation errors in 99 (63.0%). The most frequent type of error, 339 (78.5%), was a missing dose or administration frequency information. After implementation, all the patient prescriptions were reconciled when the software was used. The percentage of patients with unjustified discrepancies decreased from 63.0% to 11.8% with the use of the application (p<.001). The main type of discrepancy found on using the application was confusing prescription, due to the fact that the professionals were not used to using the new tool. CONCLUSIONS: The use of a software application has been shown to improve the quality of the information on patient treatment on the hospital discharge report, but it is still necessary to continue development as a strategy for improving medication reconciliation.

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Fundamento y objetivo. Evaluar el impacto de una aplicación informática en la mejora de la calidad de la información sobre el tratamiento domiciliario y los cambios tras la hospitalización en el informe de alta hospitalaria. Analizar la incidencia de errores y clasificarlos. Material y método. Diseño: estudio cuasi-experimental antes/después con grupo control no equivalente. Población de estudio: pacientes ingresados en plantas de especialidades médicas. Intervención: puesta en marcha de una aplicación informática integrada en la historia clínica digital. Variables: porcentaje de pacientes conciliados del total de pacientes con alta y porcentaje de pacientes con más de una discrepancia no justificada. Resultados. Se han evaluado 349 pacientes; 199 (preintervención) y 150 (postintervención). En la fase preintervención en 157 pacientes (78,8%) se había realizado el proceso de conciliación, hallándose discrepancias no justificadas en 99 (63,0%). El tipo de error más frecuente, n= 339 (78,5%), fue por prescripción incompleta. Tras la implantación, cuando se utilizó la aplicación, la conciliación se realizó en todos los pacientes. El porcentaje de pacientes con discrepancias no justificadas se redujo del 63,0% al 11,8% con el uso de la aplicación (p < 0,001). El tipo de discrepancias encontradas al usar la aplicación fue prescripción confusa, motivada por falta de familiarización de los profesionales con la nueva herramienta. Conclusiones. La utilización de una aplicación informática como apoyo al proceso de conciliación ha demostrado mejorar la calidad de la información en el informe de alta hospitalaria sobre el tratamiento del paciente, siendo necesario continuar su desarrollo como estrategia para mejorar el proceso de conciliación (AU)

Background and objective. To assess the impact of a software application to improve the quality of information concerning current patient medications and changes on the discharge report after hospitalization. To analyze the incidence of errors and to classify them. Material and method Design. Quasi-experimental pre / post study with non-equivalent control group study. Study population: Medical patients at hospital discharge. Intervention: implementation of a software application. Variables: Percentage of reconciled patient medication on discharge, and percentage of patients with more than one unjustified discrepancy. Results. A total of 349 patients were assessed; 199 (pre-intervention phase) and 150 (post-intervention phase). Before the implementation of the application in 157 patients (78.8%) medication reconciliation had been completed; finding reconciliation errors in 99 (63.0%). The most frequent type of error, 339 (78.5%), was a missing dose or administration frequency information. After implementation, all the patient prescriptions were reconciled when the software was used. The percentage of patients with unjustified discrepancies decreased from 63.0% to 11.8% with the use of the application (p < .001). The main type of discrepancy found on using the application was confusing prescription, due to the fact that the professionals were not used to using the new tool. Conclusions. The use of a software application has been shown to improve the quality of the information on patient treatment on the hospital discharge report, but it is still necessary to continue development as a strategy for improving medication reconciliation (AU)

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Objetivo: Describir la estrategia seguida en los hospitales del Servicio Andaluz de Salud para potenciar el uso seguro del medicamento utilizando como herramienta base el cuestionario de autoevaluación de la seguridad del sistema de utilización de los medicamentos en los hospitales, adaptado por el Instituto para el Uso Seguro de los Medicamentos en España. Material y métodos La estrategia se desarrolló en varias fases. Un análisis del informe de evaluación de la seguridad del sistema de utilización de los medicamentos en los hospitales públicos de Andalucía publicado por el ministerio de Sanidad y Consumo en 2008 seguido del establecimiento de un diagnóstico de partida del grado de seguridad en el uso de los medicamentos en los hospitales andaluces y priorización de las áreas de mejora. El desarrollo de un catálogo de buenas prácticas disponibles en el entorno web del observatorio para la seguridad del paciente de la agencia de calidad sanitaria andaluza, difusión de la estrategia a través de talleres formativos y la puesta en marcha de un sistema de evaluación del grado de cumplimiento de cada una de las buenas prácticas dirigido a hospitales a partir del cual componer un mapa de centros de referencia, completan las actuaciones realizadas. Resultados Se detectaron áreas de mejora en varios de los criterios esenciales del cuestionario. Estas áreas de mejora se relacionaron con procesos habituales que sigue el medicamento en la práctica clínica habitual. Así, se elaboraron 7 guías de buena práctica que recogen de forma transversal todos los elementos de evaluación del cuestionario relacionados con el proceso clínico a mejorar. Conclusiones El cuestionario de autoevaluación adaptado por ISMP-España constituye una buena herramienta para diseñar una intervención sistemática y racional en el uso seguro del medicamento dirigida a un grupo de hospitales que comparten los mismos valores (AU)

Objective: To describe the strategy employed by Andalusian public health service hospitals to foster safe medication use. The self-evaluation questionnaire on drug system safety in hospitals, adapted by the Spanish Institute for Safe Medication Practices was used as a fundamental tool to that end. Material and method: The strategy is developed in several phases. We analyse the report evaluating drug system safety in Andalusian public hospitals published by the Spanish Ministry of Health and Consumption in 2008 and establish a grading system to assess safe medication practices in Andalusian hospitals and prioritise areas needing improvement. We developed a catalogue of best practices available in the web environment belonging to the Andalusian health care quality agency’s patient safety observatory. We publicised the strategy through training seminars and implemented a system allowing hospitals to evaluate the degree of compliance for each of the best practices, and based on that system, we were able to draw up a map of centres of reference. Results: We found areas for improvement among several of the questionnaire’s fundamental criteria. These areas for improvement were related to normal medication procedures in daily clinical practice. We therefore wrote 7 best practice guides that provide a cross-section of the assessment components of the questionnaire related to the clinical process needing improvement. Conclusions: The self-evaluation questionnaire adapted by ISMP-Spain is a good tool for designing a systematic, rational intervention to promote safe medication practices and intended for a group of hospitals that share the same values (AU)

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OBJECTIVE: To describe the strategy employed by Andalusian public health service hospitals to foster safe medication use. The self-evaluation questionnaire on drug system safety in hospitals, adapted by the Spanish Institute for Safe Medication Practices was used as a fundamental tool to that end. MATERIAL AND METHOD: The strategy is developed in several phases. We analyse the report evaluating drug system safety in Andalusian public hospitals published by the Spanish Ministry of Health and Consumption in 2008 and establish a grading system to assess safe medication practices in Andalusian hospitals and prioritise areas needing improvement. We developed a catalogue of best practices available in the web environment belonging to the Andalusian health care quality agency's patient safety observatory. We publicised the strategy through training seminars and implemented a system allowing hospitals to evaluate the degree of compliance for each of the best practices, and based on that system, we were able to draw up a map of centres of reference. RESULTS: We found areas for improvement among several of the questionnaire's fundamental criteria. These areas for improvement were related to normal medication procedures in daily clinical practice. We therefore wrote 7 best practice guides that provide a cross-section of the assessment components of the questionnaire related to the clinical process needing improvement. CONCLUSIONS: The self-evaluation questionnaire adapted by ISMP-Spain is a good tool for designing a systematic, rational intervention to promote safe medication practices and intended for a group of hospitals that share the same values.

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OBJECTIVE: To analyze drug-related adverse events (DRAE) as noted in hospital discharge reports, as well as their severity and drugs involved, and to assess potential avoidability. MATERIAL AND METHODS: A retrospective study for the September-December 2002 period of time in which patients with discharge reports including an ICD-9-CM code E930-E949.9 were selected using the minimum basic data set (MBDS). RESULTS: DRAEs were detected in 2.15% of all discharge reports, and 229 were retrospectively assessed. In all, 62.45% (n = 143) were DRAEs detected at the Emergency Department, and 37.55% (n = 86) were DRAEs detected during hospitalization. Of these, 57.20% are considered potentially avoidable. Drugs most commonly involved in the outpatient DRAE sample studied included: digoxin (24.47%, avoidable 97.14%) and NSAIDs-opioids (13.98%, avoidable 75%). Inpatient DRAEs included: anticoagulants (30.23%, avoidable 57.69%) and antimicrobials (17.44%, avoidable 26.67%). CONCLUSIONS: The study revealed a high proportion of preventable DRAEs around a small number of drugs. Information to prescribing doctors and procedures for treatment follow-up using a unit dose drug dispensing system may be useful to reduce this.

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