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Accuracy in the medication history and reconciliation errors in the emergency department
Adecuación de la historia farmacoterapéutica y errores de conciliación en un servicio de urgencias
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Thus, we know that up to 60% MEs occur during the admission process, inter-level transfers and at discharge.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Admission, either programmed or through the emergency department, is critical, as it has been detected that discrepancies are frequent between chronic home medication and hospital prescriptions. These discrepancies when they are involuntary and are not justified by clinical requirements can lead to negative consequences on the patient (affecting both efficacy and safety) and constitute the so-called reconciliation errors (REs).<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">As it usually happens in the case of MEs, the causes of REs are multifactorial.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> However, one major problem is the difficulty to obtain the list of the patient's home medication. Currently there is no gold standard, and various factors such as the lack of unified records in health care, lack of access to medical records, the use of different health systems (private health care, alternative medicine, etc.) or ignorance from the patient about treatment, greatly hinder the process. An incomplete initial anamnesis makes it difficult for the diagnostic orientation of patient's symptomatology and may cause potential prescription errors during hospitalization.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Several studies on the quality of drug anamnesis estimate the percentage of histories with discrepancies range from 27 to 83%, depending on the type of drug.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a> In the field of hospital emergency departments (EDs), it is estimated that 80–95% of patients may be affected by some discrepancies in their drug histories.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">8–10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Despite the growing number of studies in this field, many of them have some limitations such as improper differentiation between the concepts of discrepancy in medical history and RE, not verifying the medication list with the patient or not confirming with the attending physician the discrepancies detected. In these cases, it is difficult to understand the clinical relevance of the findings.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The purpose of this study is to obtain a qualitative and quantitative description of both processes (recording home medication and reconciliation) at the ED, and how the presence of a clinical pharmacist can help detect and minimize such errors. In addition, factors associated with the occurrence of REs were assessed.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">Single-center, prospective interventional study, 4 month-duration (November 2011–March 2012) in the observation area of the emergency department of a tertiary care university hospital assisting about 90,000 visitors a year. In accordance with the ED operation, the medication history is obtained by the doctor and can take place in 3 moments: the first contact with the physician (first visit), after an initial assessment (after-visit area) or in the observation area. This history should be recorded in the patient's medical records.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Adult patients aged over 18 were admitted to the observation area (room for up to 28 patients, where mainly, but not only, patients in the level III are referred to according to the Andorran Triage Model [ATM]<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">11</span></a>). They were assisted by ED physicians, and were able to respond to interview questions (or a family member or caregiver who could perform this function) and agreed to participate in the study. All patients who could not be interviewed because of language barriers or physical status (e.g., disoriented or sedated patient) were excluded. Also, all cases in which the detected discrepancies could not be verified by the physician in charge were excluded from the RE analysis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Patients were recruited from Monday to Friday at 8.00<span class="elsevierStyleHsp" style=""></span>am by a random selection. The frequency of patients with medication history errors was expected to be 85%.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">7,10</span></a> To obtain a 5% accuracy in estimating the ratio by a 95% bilateral CI, and with a 5% loss, it was calculated that 206 patients needed to be included.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The pharmacist interviewed all patients included, using a standardized form in order to obtain the home medication list. Home medication was defined as the medication a patient takes regularly at home, including OTC drugs, herbal products and alternative medicine. Whenever possible, the interview was based on a preliminary list of medications constructed from every source of information available (medical history, prescriptions, medication lists or boxes provided by the patient, discharge reports, etc.). Subsequently, this reference list was compared to: (1) the patient's medical history previously recorded in the computer system (evaluation of the medication history quality), and (2) the medication prescribed during their stay in the ED (evaluation of reconciliation).</p><p id="par0055" class="elsevierStylePara elsevierViewall">For evaluating reconciliation, the consensus methodology provided by the Sociedad Española de Farmacia Hospitalaria or SEFH (Spanish Society of Hospital Pharmacy)<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">12</span></a> was followed. The therapy prescribed for acute problem was always considered as justified discrepancy. If any discrepancy not justified by the new clinical situation was detected, this was discussed with the attending physician to determine if it was a RE.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Outcome variables were: (1) percentage of discrepancies between medication recorded by the physician in the medical history and the list obtained by the pharmacist, and (2) percentage of RE. Discrepancy was defined as omission of, or difference between, the drugs, dosage or route of administration. REs were all unjustified discrepancies between the patient's home medication and the prescribed medication in the ED, which after being discussed with the attending physician was modified or readjusted.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">12,13</span></a> For the RE classification, recommendations of the SEFH consensus document were followed.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">12</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">As additional variables, data concerning the patient, the reason for consultation and the reconciliation process were recorded: sex, age, level of triage according to ATM, polypharmacy (≥5 drugs regularly), person in charge of medication (patient, caregiver, residence), grounds for visit, interview timing and information sources used.</p><p id="par0070" class="elsevierStylePara elsevierViewall">For statistical analysis, SPSS<span class="elsevierStyleSup">®</span> statistical application (v 15.0) (SPSS Inc., Chicago, IL, USA) was used. The qualitative variables were described as percentages, and the quantitative variables as mean accompanied by its variability (standard deviation [SD] or range). Student <span class="elsevierStyleItalic">t</span>-test was used for comparing means, and a univariate analysis was used to identify the variables associated with the presence of RE. In all cases a 0.05 significance level was used.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">During the study period 227 medication histories were conducted, and 214 were eligible for analysis (13 cases were excluded because of inability to verify the information with the attending physician).</p><p id="par0080" class="elsevierStylePara elsevierViewall">The mean age of patients was 70 years (range 18–102 years), and 42% were male. 79% patients were assigned to level III according to the ATM, and 17% to level II. In over half the cases the patient was responsible for their own medication (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The main reasons for visiting the ED were dyspnea (35%), fever (9%) and general discomfort (6%).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Almost half of the interviews (45%) had some source of additional supporting information, mainly: electronic prescriptions (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>31), residence/social and health care reports (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>24), reports on discharge (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>10) and reports from primary care (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>10). Boxes of medication and patients’ own lists were obtained in 2 and 3% of them, respectively. Mean time spent on the interview was 5.38<span class="elsevierStyleHsp" style=""></span>min/patient (3.34 SD; range 1–35<span class="elsevierStyleHsp" style=""></span>min).</p><p id="par0090" class="elsevierStylePara elsevierViewall">The pharmacist identified 1474 regular prescriptions, with a 6.89 mean (4.43<span class="elsevierStyleHsp" style=""></span>SD) drugs/patient, compared to the doctor, who recorded 1220 drugs in total, with a 5.70 mean (4.53<span class="elsevierStyleHsp" style=""></span>SD) drugs/patient (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). A total of 1596 medication lines were verified and 980 discrepancies in medication histories were identified involving 85% patients (92% if patients without home medication are excluded). The average discrepancy per patient was 4.58 (4.03<span class="elsevierStyleHsp" style=""></span>SD). Only 39% prescriptions recorded in medication history were correct as a whole.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The main cause of discrepancy was the omission of treatment (39%) or dosage (33%) information. The physician noted down in medication history 135 drugs that the patient was no longer taking (drug commission). In 3.7% cases the medication recorded was erroneous (for example, esomeprazole instead of pantoprazole) and 10% drugs written in the medical history were recorded at a wrong dosage (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The reconciliation process was conducted on 197 patients taking medication regularly. A total 1906 medication lines were reviewed, most of which had no discrepancies compared to the prescribed treatment (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>485; 25%), or these were justified by the patient's clinical condition (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1188; 62%) and accounted for acute treatment scheduled in the ED, mainly.</p><p id="par0105" class="elsevierStylePara elsevierViewall">In 233 cases the differences were not justified and required clarification from the physician. In 157 cases (68%) discrepancy was considered as RE, involving nearly half of the sample (43%). The mean error per patient was 0.81 (1.17<span class="elsevierStyleHsp" style=""></span>SD).</p><p id="par0110" class="elsevierStylePara elsevierViewall">The major causes of RE detected were the omission of a regular treatment to be maintained (62%) and differences between scheduled dosage in the ED and the standard dosage (16%). The 3 main pharmacological groups involved were: cardiovascular system (34%); nervous system (21%), and those used in diseases of the digestive system and metabolism (19%). Details of the RE types and the drugs involved are shown in <a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>, respectively. In all groups, the main type of RE was the omission of treatment, consistent with the overall result.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Finally, the results of the univariate analysis identified age and polypharmacy as factors associated with the occurrence of REs, while the presence of a caregiver or family responsible for the medication was associated with a lower risk. Significantly more errors were found in patients providing any source of additional information. The fact that the patient showed anamnesis errors was not identified as associated factor (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">The percentage of patients with discrepancies detected in their history records in this study was high (85%), and stands at the top edge of rates reported by similar studies (10–96%).<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a> This high percentage of inaccuracies can be influenced by the definition of discrepancy used (including assessment of both the drug and dosage), because the analysis included OTC drugs and due to the demographic characteristics of the patients included. Most patients were elderly, with many pathologies and polypharmacy, characteristics that may be associated with increased disease severity.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">14</span></a> Polypharmacy is also a major risk variable in ME.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">10,15</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The main cause of discrepancy was the omission of information on both the drug (39%) and dosage (33%), consistent with previous work, although in some cases percentages differ from ours and may reach 61%.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">8,10,16</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Additionally, the results of this study also show that the quality of the medication history varies depending on the professional involved in their production. Therefore, the pharmacist was able to identify a significantly higher number of drugs per patient than the physician. Depending on the center, the process to obtain the medication history can be performed by different professionals (attending physicians, residents, nurses, pharmacists, pharmacy technicians), with varying degrees of experience. It would be desirable, in future studies, to analyze the characteristics of these professionals obtaining the best quality medication histories.</p><p id="par0135" class="elsevierStylePara elsevierViewall">In the case of pharmacists, more time devoted to interviews, the use of standardized forms and lower work load might be some of the reasons of the difference observed, although the determination of these factors is beyond the scope of this study.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Regarding REs, even though a large number of discrepancies between chronic medication and prescription in the ED were detected (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1421), most of them were justified by the patient's clinical condition (83.6%). This factor is particularly relevant in an environment such as the ED, where patient's acute condition is prevailing and can lead to necessary changes in their regular treatment. A proper reconciliation does not necessarily imply to prescribe the full list of the home medication.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">In our study, over half of the discrepancies were confirmed as REs and involved 43% patients. This value is comparable to the prevalence found by Cornish et al. in a room of Internal Medicine,<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">18</span></a> but is significantly lower than the results obtained in 2 EDs in our environment, in which REs were found in 71.9 and 87% patients.<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">19,20</span></a> In the second case, the methodology does not explain whether or not the detected discrepancies need to be confirmed with the doctor, and this might be one of the causes of the difference in the percentages obtained. Another potential cause might be a lower acceptance rate of pharmacist interventions.</p><p id="par0150" class="elsevierStylePara elsevierViewall">As for characterizing the detected RE the omission of a regular patient's treatment that should be maintained is noted. This is also the main type of error found in previous studies, and has been identified as a potential cause of AE occurrence.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">18,21,22</span></a> There are little data on the type of drugs involved in the REs. In our study, the cardiovascular and central nervous system treatments were the most involved in REs, consistent with the study by Cornish et al.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">18</span></a> The potential severity of detected REs is highly variable depending on the type of error and the active substance involved. Abrupt discontinuation of many of the drugs detected during the study may cause withdrawal syndrome (nitrates, beta blockers, calcium channel blockers, antidepressants, opioids, antiparkinsonian agents, etc.), dyskinesia and agitation (antipsychotics) and risk of bronchospasm (tiotropium), among other AEs. However, in the context of EDs, the REs associated with statins and proton-pump inhibitors have very low potential to harm the patient.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a> All REs were detected and understood early and none was harming the patient. However, previous studies have found that about 50% of the AEs detected in the ED may be related to omission of regular treatment.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">23</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">The analysis of the variables associated with REs offered some unexpected results. The elderly and polypharmacy were identified, predictably, as factors associated with the occurrence of REs,<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">10</span></a> as well as the availability of additional sources of information. One possible explanation is that the availability of these resources will facilitate the detection of potential REs, not their appearance. Additionally, our study identified a potential ‘protection’ factor: a relative or caregiver is in charge of the medication. We hypothesize that this parameter can be particularly important in patients with communication problems, because of their advanced age or clinical condition.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Finally, and unexpectedly, no association between the discrepancies in the anamnesis and REs was found. From our point of view this might be due to the high percentage of patients with discrepancies in the collection of medication data or the use of electronic information systems. Despite the many benefits provided by these tools, there is concern that they may be a source of new types of error due to system failures or incorrect use. Improper use may lead to loss of relevant information and communication problems among professionals (e.g., verbal changes in treatment that are not included in the history, no start and end dates of prescriptions).<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">24,25</span></a> In addition, several studies have begun to detect, in institutions with electronic health records, the so-called copy-paste phenomenon.<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">26,27</span></a> Physicians, being aware of this problem which can influence the quality of information, might not entirely rely on the data collected and choose to complete the information with other sources. However, this is just a new hypothesis that should be confirmed in future studies specifically designed for this purpose.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Inevitably our work has some limitations. The major limitation, common to all the studies reviewed, is the lack of a gold standard for obtaining the list of home medication. In this study, the reference was the list obtained from various sources and it was verified with the patient in an interview. Therefore, the sample was restricted to those individuals able to adequately answer certain questions, which is not always possible in routine clinical practice. Second, the data collection was standardized, carried out early in the morning (not always before the first prescription) only on weekdays and it only included one center. Therefore, the extrapolation of results should be undertaken with caution. Finally, our study did not include implementation, systematically, of any tools that would transmit the information to the next level of care, so we cannot determine the impact of our intervention beyond the results obtained in the ED.</p><p id="par0170" class="elsevierStylePara elsevierViewall">However, from our point of view, one of the main strengths offered by our work is that it is the first study to evaluate simultaneously, and on the same population, both the quality of the medication history and the reconciliation process, using a standardized methodology. Additionally, we believe that interviews with the patient and the attending physician enrich the information obtained.</p><p id="par0175" class="elsevierStylePara elsevierViewall">The use of home medication in the ED is complex and they frequently, in the acute condition, go to the background, sometimes even being under the control of the patient. However, proper medication history can play a significant role in finding a diagnosis. The results of our study show that both the collection of the medication history and the reconciliation process in the ED involve a large number of patients and can be improved. It is therefore necessary to provide integrated access to various information systems, and insist on the quality of the data contained in them. These improvements also require the professionals to be more involved, by implementing medication reconciliation programs conducted by multidisciplinary teams.</p><p id="par0180" class="elsevierStylePara elsevierViewall">The pharmacist can help obtain a medical history of quality and increase patient's safety in the ED identifying and intercepting potential REs.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a> Their involvement might be particularly beneficial in high-risk groups. Further studies are required aimed at evaluating the impact of training measures, the development of electronic resources and determining the impact of reconciliation in the ED over the next care transition.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0190" class="elsevierStylePara elsevierViewall">The completion of this work has been funded with the Emili Letang end-of-residency award.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interest</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors report no conflict of interest regarding the contents of this article.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres624724" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec638079" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres624725" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec638078" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-10-25" "fechaAceptado" => "2015-02-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec638079" "palabras" => array:6 [ 0 => "Reconciliation" 1 => "Pharmaceutical anamnesis" 2 => "Patient safety" 3 => "Medication error" 4 => "Discrepancies" 5 => "Emergency department" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec638078" "palabras" => array:6 [ 0 => "Conciliación" 1 => "Historia farmacoterapéutica" 2 => "Seguridad del paciente" 3 => "Error de medicación" 4 => "Discrepancias" 5 => "Urgencias" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the accuracy of pharmaceutical anamnesis obtained at the Emergency Department (ED) of a tertiary referral hospital and to determine the prevalence of medication reconciliation errors (RE).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a single-center, prospective, interventional study. The home medication list obtained by a pharmacist was compared with the one recorded by a doctor to identify inaccuracies. Subsequently, the home medication list was compared with the active prescription at the ED. All unexplained discrepancies were checked with the doctor in charge to evaluate if a RE has occurred. A univariate analysis was performed to identify factors associated with RE.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The pharmacist identified a higher number of drugs than doctors (6.89 versus 5.70; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). Only 39% of the drugs obtained by doctors were properly written down in the patient's record. The main cause of discrepancy was omission of information regarding the name of the drug (39%) or its dosage (33%). One hundred and fifty-seven RE were identified and they affected 85 patients (43%), mainly related to information omission (62%). Age and polymedication were identified as main risk factors of RE. The presence of a caregiver or relative in the ED was judged to be a protective factor. No relationship was found between inaccuracies in the registries and RE.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The process of obtaining a proper pharmaceutical anamnesis still needs improvement. The pharmacist may play a role in the process of obtaining a good quality anamnesis and increase patient safety by detecting RE. Better information systems are needed to avoid this type of incidents.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Fundamento y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar la calidad de la historia farmacoterapéutica registrada en un servicio de urgencias hospitalario (SUH) de un hospital de tercer nivel. Determinar la prevalencia de errores de conciliación (EC).</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio unicéntrico, prospectivo y de intervención. Se comparó la lista de medicación habitual obtenida por un farmacéutico frente a la registrada por el médico para identificar discrepancias. Posteriormente, se comparó la medicación habitual con la prescripción activa (SUH). Todas las discrepancias no justificadas se comentaron con el médico para determinar si se trataba de un EC. Se realizó un análisis univariante para identificar factores asociados con la aparición de EC.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El farmacéutico identificó un mayor número de fármacos habituales por paciente respecto al médico (6,89 frente a 5,70; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05). Únicamente el 39% de los fármacos identificados por el médico se registraron correctamente en la historia clínica. La principal causa de discrepancia fue la omisión de información a nivel de fármaco (39%) o de posología (33%). Se detectaron 157 EC que afectaron a 85 pacientes (43%), mayoritariamente por omisión (62%). Los principales factores asociados a EC fueron la edad y la polimedicación. La presencia de un cuidador/familiar responsable de la medicación fue un factor protector. No se encontró asociación entre discrepancias en el registro y EC.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La recogida de la historia farmacoterapéutica es un proceso susceptible de mejora. El farmacéutico puede ayudar a obtener una anamnesis de calidad e incrementar la seguridad del paciente interceptando EC. Es necesario mejorar los sistemas de información para evitar este tipo de incidentes.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: de Andrés-Lázaro AM, Sevilla-Sánchez D, Ortega-Romero MM, Codina-Jané C, Calderón-Hernanz B, Sánchez-Sánchez M. Adecuación de la historia farmacoterapéutica y errores de conciliación en un servicio de urgencias. Med Clin (Barc). 2015;145:288–293.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1145 "Ancho" => 1627 "Tamanyo" => 97035 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Types of discrepancies detected between the physician's and pharmacist's medical history.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">SD: standard deviation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Male sex, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 (42) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age in years, mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 (18.97) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><65, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62 (28.97) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>65–80, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 (31.77) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>>80, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84 (39.25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Level of triage, n (%)</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 (17.29) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">169 (78.97) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (2.80) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.47) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Polypharmacy patients (≥5 usual drugs), n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">144 (67.29) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Patients with no home medication, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (7.94) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Responsible of medication, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">144 (67.29) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Caregiver \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (21.96) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Residency/social-health \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (10.75) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1024696.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">According to the Andorran Triage Model.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">General characteristics of the study population (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>214).</p>" ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">MG: medication guidelines; MH: medical history; ED: hospital emergency department.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of reconciliation error \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage (n) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Examples \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Omission of drug \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.42 (98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Omission of the regular treatment with paroxetine in elderly patient who complains of dyspnea. Risk of withdrawal syndrome \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Discrepancy in dosage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.92 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Patient with heart disease on a regular digoxin therapy scheduled inadvertently as twice his maintenance dose \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Drug not included in guidelines \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.73 (9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Torasemide prescription as part of antihypertensive therapy in a patient. As it was not included in the MG, it should have been replaced by another similar diuretic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Drug commission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.10 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Combined prescription of citalopram and sertraline in the ED. The patient had completed treatment with citalopram months ago. The source of the error was a failure to update the MH (both drugs were registered as regular treatment) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Different drug \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.10 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prescription of immediate release morphine instead of the sustained release morphine received by the patient regularly to control chronic pain \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Incomplete prescription \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.10 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Incomplete command “pramipexole 1<span class="elsevierStyleHsp" style=""></span>c/day.” Tablets are available in different dosage \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duplicity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.64 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Simultaneous prescription of inhaled tiotropium (patient's regular treatment) and nebulized ipratropium (acute treatment initiated in the ED) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1024695.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Types of reconciliation errors.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">OAC: oral anticoagulants; ARA II: angiotensin II receptor antagonists; BPH: benign prostatic hyperplasia; PPI: proton-pump inhibitor; ACEI: angiotensin-converting enzyme inhibitors.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pharmacological group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage (n) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Drugs involved \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiovascular system \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34.39 (54) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Statins (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13); ACEI (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9); cardiac treatment (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>, nitrates, digoxin, etc.); calcium channel blockers (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8); alpha-adrenergic antagonists (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8); beta-blockers (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4); ARA II (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4); diuretics (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nervous system \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.02 (33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Psychoanaleptics (antidepressants, n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>14; drugs for dementia, n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2); psycholeptics (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7; antipsychotics, anxiolytics); opioid analgesics (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4); antiepileptics (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4); antiparkinsonian (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Digestive system and metabolism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.11 (30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PPI (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>19); insulins (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7); non-insulin antidiabetics (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3); potassium (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blood and hematopoietic organs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.46 (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Antiplatelet (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11); OAC (acenocumarol, n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5; dabigatran n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1); folic acid (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hormonal therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.73 (9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Thyroid hormones (levothyroxine, n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7); systemic corticosteroids (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1); antithyroid preparations (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Genitourinary therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.55 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Antiandrogens (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2); drugs for BPH (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-infective therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.55 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sulfonamides<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>trimethoprim (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2); fluoroquinolones (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1); reverse transcriptase inhibitors (lamivudine, n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Antineoplastic therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.91 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Calcineurin inhibitors (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2); Aromatase inhibitors (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Musculoskeletal system \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.64 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Antigout agents (allopurinol, n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Respiratory system \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.64 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Inhaled anticholinergics (ipratropium n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1024697.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Drugs involved in reconciliation errors.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Univariate analysis of factors associated with the occurrence of reconciliation errors. Statistically significant variables were those whose 95% confidence intervals do not contain value 1.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients with reconciliation errors, n (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative risk \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% confidence interval \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 (46.25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reference \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (41.02) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.64–1.22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Age in years</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (29.79) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reference \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>65–80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (53.03) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.09–2.92 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>≥80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 (42.86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.87–2.38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Regular therapy</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><5 drugs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (16.98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reference \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>≥5 drugs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 (52.78) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.68–5.75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">In charge of medication</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 (46.45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reference \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Caregiver/relative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (27.66) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.36–0.98 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Residency/social-health \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (56.52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.81–1.82 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Additional information source</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 (33.33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reference \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 (52.47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.12–2.21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Discrepancies in anamnesis</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79 (43.89) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reference \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (35.29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.41–1.56 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1024698.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Risk factors for reconciliation errors.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0145" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The nature of adverse events in hospitalized patients. 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