[AN INVESTIGATION INTO THE ROLE OF A REHABILITATION HOSPITAL PHARMACIST IN DETERMINING DISCREPANCIES AND MEDICATION ERRORS DURING PATIENTS` ADMISSION].

INTRODUCTION: The importance of correcting medication errors at hospital admission is paramount for promoting error-free delivery and continuity of care. Recently stakeholders have paid considerable attention to patient safety in acute-care hospitals but less is known about discrepancies and medication errors during patients` admission in other health care settings, such as post-acute care providers. An increased understanding of errors that occur in rehabilitation hospitals, would better equip stakeholders in taking actions to improve the safety of patient care in this unique setting.

AIMS: The primary aim of the current study, conducted in a rehabilitation health care setting, is to study the pharmacist's role in identifying and preventing unintended medication discrepancies at the time of their hospital admission. The lack of available information on medications errors associated with medicines' risk factors and patients' characteristics, led the researcher to her secondary objective: to study the source of error, type of discrepancy and class of medicine most frequently implicated during the transition of care from an acute to a rehabilitation hospital.

METHODS: The researcher performed a retrospective investigation and study of 356 patients with 3071 prescription medications referred from an acute hospital. The inclusion criteria also included ventilated patients over the age of 18 who received more than five prescription-only medicines. Over a period of 12 months, the investigator ascertained what medications were used prior and post-admission stage and then compared these drugs. The discrepancies identified were discussed with the attending physician. Unintended discrepancies were classified as errors.

RESULTS: Unexplained errors which resulted in physician changes affected 154 patients, 43% of the total number of the study participants. The findings show that the most common cause of error found during the reconciliation of medicines at the point of admission is the use of patients own medications in the process. The most accurate and up to date source of information during the reconciliation process is the medication list brought with the patient upon admission. The wrong route of administration was the most common type of error that was found. Errors were concerned with important drug categories such as cardiovascular and antidiabetic drugs. The average number of drugs per patient is 9, while each of the studied population had a mean of two or more errors in admission. Although men were treated with an average of 10 medicines and females received only 8, the number of discrepancies was higher in females.

CONCLUSIONS: Pharmacists play an important role in determining discrepancies and medication errors during patients` admission. This study provides an insight into the discrepancies that occur in this unique setting. Stakeholders may wish to adopt the recommendations provided by the author and act in order to improve the patients' safety in rehabilitation hospitals. Some of the recommendations are also applicable to other health care settings.