Usklađivanje terapije na prijemu u bolnicu kod kardioloških bolesnika starije životne dobi

master's thesis

• Title (english): Medication reconciliation at hospital admission in elderly patients with cardiovascular diseases
• Author: Gabrijela Balog
• Mentor: Maja Ortner Hadžiabdić (mentor)
• Mentor: Ivana Marinović (mentor)
• Committee member: Maja Ortner Hadžiabdić (predsjednik povjerenstva)
• Committee member: Ivana Marinović (član povjerenstva)
• Committee member: Ivana Samardžić (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Centre for applied pharmacy); Zagreb
• Defense date and country: 2024-02-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

Usklađivanje terapije je proces uspoređivanja najbolje moguće medikacijske povijesti (NMMP) i lijekova koje je propisao liječnik prilikom prijema, premještanja i otpusta bolesnika iz bolnice nakon čega slijedi identificiranje i rješavanje svih odstupanja. NMMP se opisuje kao sveobuhvatna povijest lijekova koje je pacijent koristio prije hospitalizacije, a njeno detaljno prikupljanje predstavlja temelj uspješnog procesa usklađivanja terapije.
Svrha ovog istraživanja bila je utvrditi učestalost nenamjernih odstupanja između lijekova propisanih od liječnika i onih koje su kardiovaskularni bolesnici starije životne dobi koristili prethodno hospitalizaciji, kao i njihov potencijal za izazivanje kliničkog pogoršanja i štete za pacijenta.
Istraživanje je provedeno na Zavodu za bolesti srca i krvnih žila u Kliničkoj bolnici Dubrava. U njemu je sudjelovalo 105 ispitanika starije životne dobi (≥ 65 godina), a većina njih (90,5%) je bila hospitalizirana nakon hitnog prijema. Klinički je farmaceut unutar 24h od prijema prikupio NMMP i usporedio ju s propisanom farmakoterapijom. Nenamjerna odstupanja koju su pritom pronađena podijeljena su prema vrsti u šest skupina. Također, s obzirom na potencijal da izazovu kliničko pogoršanje i štetu pacijentu, odstupanja su klasificirana u tri razreda.
Odstupanja u terapiji pronađena su kod 96 ispitanika, a 10,2% tih odstupanja nije imalo kliničkog opravdanja što znači da su ona bila nenamjerna. Barem jedno takvo odstupanje pojavilo se kod 38 pacijenata (36,2 % svih sudionika). Izostavljanje lijeka je vrsta odstupanja koja je najčešće utvrđena, čineći 70,18% svih nenamjernih odstupanja. Većina njih (71,93%) mogla je izazvati umjereno kliničko pogoršanje, a 10,53% nenamjernih odstupanja imalo je potencijal izazivanja ozbiljnog kliničkog pogoršanja.
Zaključno, usklađivanje terapije je proces koji otkrivajući nenamjerna odstupanja ima veliku ulogu u povećanju sigurnosti prilikom korištenja lijekova. To je od posebne važnosti za pacijente s politerapijom koji su time značajno podložniji riziku od medikacijskih pogrešaka, a to su često osobe starije životne dobi te kardiovaskularni bolesnici. Stoga je potrebno istaknuti ulogu kliničkih farmaceuta koji su se pokazali kao najkompetentniji stručnjaci za dobivanje potpune i točne medikacijske povijesti.

Abstract (english)

Medication reconciliation is a process of comparing the Best Possible Medication History (BPMH) with the medicines prescribed by a physician upon the patient's admission, transfer and discharge from the hospital, followed by the identification and resolution of all discrepancies. The BPMH is described as a comprehensive history of medicines used by a patient prior to hospitalization, and its detailed collection is the basis of successful medication reconciliation process.
The aim of this study was to determine the frequency of unintentional discrepancies between medicines prescribed by a physician and those used by elderly patients with cardiovascular diseases prior to hospitalization, as well as their potential to cause clinical deterioration and harm to the patient.
The study was conducted at the Department of Cardiovascular Diseases at the Dubrava Clinical Hospital. It included 105 elderly examinees (≥ 65 years), and most of them (90.5%) were hospitalized after emergency admission. Within 24 hours of admission, a clinical pharmacist collected BPMH and compared it with the prescribed pharmacotherapy. Unintentional discrepancies found in doing so were divided according to the type into six groups. Also, considering the potential to cause clinical deterioration and harm to the patient, discrepancies are classified into three classes.
Medication discrepancies were found in 96 participants, and 10.2% of these discrepancies had no clinical justification which means that they were unintended. At least one such discrepancie occurred in 38 patients (36.2% of all participants). Omission of the drug is the most frequently detected type of discrepancie, accounting for 70.18% of all unintentional discrepancies. The majority of them (71.93%) were able to cause moderate clinical deterioration, and 10.53% of unintentional discrepancies had the potential to cause serious clinical deterioration.
In conclusion, medication reconciliation is a process that, by detecting uintentional discrepancies, plays a major role in increasing safety when using medicines. This is of particular importance for patients with polytherapy, who are therefore significantly more suspectible to the risk of medication errors, and these are often elderly people and patients with cardiovascular diseases. It is therefore necessary to highlight the role of clinical pharmacist who have proven to be the most competent experts in obtaining a complete and accurate medication history.

• Keywords: usklađivanje terapije; najbolja moguća medikacijska povijest; nenamjerna odstupanja; starija životna dob; kardiovaskularni bolesnici; prijem u bolnicu
• Keywords (english): medication reconciliation; Best Possible Medication History; unintentional discrepancies; older age; cardiovascular patients; hospital admission
• Language: croatian
• URN:NBN: urn:nbn:hr:163:558923
• Study programme: Title: Pharmacy - integrated undergraduate and graduate - university study; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: sveučilišni magistar farmacije (sveučilišni magistar farmacije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-05-08 10:50:33