Study On The Incidence And Related Factors Of Medication Discrepancy In Hospital-family Transitional Period In Elderly Patients With Chronic Kidney Disease

OBJECTIVETo evaluate the occurrence and causes of medication discrepancy in hospital-family transitional age in patients with chronic kidney disease(CKD);to explore the factors that influence the occurrence of medication discrepancy bias in elderly patients with CKD;to analyze the medication discrepancy in the hospital-family transition period for drugs The impact of adverse events is expected to provide a basis for the clinical development of more effective nursing care measures during the transition period.METHODSIn this study,a single-center survey was used to study elderly patients with CKD who had undergone transition from hospital to family.Select 145 elderly patients with CKD who were discharged from the Nanjing General Hospital of the People's Liberation Army from February to November 2017.A baseline survey was conducted 2 days before discharge.The questionnaire included 12 items in three areas:patient demographics,disease-related data,and medication-related data.One week after the patient was discharged,the patient's occurrence of medication discrepancy was assessed by telephone follow-up.The Chinese version of the Medication Discrepancy Tool(MDT)was used to examine and record the medication discrepancy between the five aspects of actual medication,dose,frequency,time,and route taken by the patient in the family and the prescription of the discharged medication.The reasons for the occurrence of medication discrepancy were confirmed through interviews with patients and family members,doctors and nurses,and access to medical documents.Through telephone follow-up and outpatient visits,assess whether the patient has an adverse drug event(ADE).Excel was used to establish the database,and SPSS 23.0 software was used for statistical analysis.Measured data were expressed as mean ? standard deviation,and the t test was used for analysis.The count data were analyzed using the number of cases and percentages,chi-square test and Fisher's exact probability method.Logistic multiple regression was used to analyze the influencing factors.RESULT1.Among 145 elderly CKD patients,73(50.34%)had at least 1 medication discrepancy of medication,and 158 medication deviations occurred,averaging 2.16 per person.2.Reduction of drug(45.57%)and inconsistent drug use time(25.32%)were the main types of medication discrepancy;45 patients(46.87%)who took antihypertensive drugs had deviations from medication,20 cases of anticoagulant drugs.(40.0%),13 cases(39.39%)of hypoglycemic agents and 34 cases(38.20%)of immunosuppressive agents.Unintentional disobedience(27.21%)and inaccurate discharge medication education(15.82%)were the main causes of medication discrepancy.3.Logistic regression results showed that there were more than 5 medical orders(P =0.033),DRUGS score was less than 80 points(P = 0.003),CKD 3-5(P = 0.030),and family care index was less than 7 points(P).= 0.013),an independent risk factor for medication discrepancy.4.In 145 elderly CKD patients,11 cases(7.59%)of ADE occurred within one week after discharge,and 6 cases(4.14%)of preventable ADE caused by medication discrepancy.Of these,4(4/6,66.67%)involved system-medication discrepancy,2(2/6,33.33%)involved patient-medication discrepancy,and no hospitalization was due to ADE for 30 days after discharge.CONCLUSION1.The incidence of medication discrepancy in elderly patients with CKD is high after hospital discharge,and it will increase the occurrence of ADE in hospital-family transitional period.Nursing personnel need to strengthen the communication between doctors,family members and patients during hospital-family transition period.,education and coordination.2.Caused the medication discrepancy of hospital-home transitional drug use in elderly patients with CKD.The patient-originated cause accounted for a large proportion,which was mainly reflected in the lack of ability of elderly CKD patients to execute drug prescriptions.The main reason for system-lever medication discrepancy is that the patient's medication information has not been transmitted effectively and accurately during the transition period.3,Family care index,the number of doctor's orders,CKD staging and DRUGS scores can be listed as screening items for elderly CKD patients,and the use of high-risk patients to strengthen the transition period of drug care follow-up.4.It is recommended that transitional nurses be set up to apply medication care throughout the hospital-family transitional period.Individualized medication education was given to patients prior to discharge,with emphasis on improving the ability of elderly CKD patients to understand prescriptions,implementation capabilities,and the ability to communicate medication information across medical platforms.Transitional nurses should also actively coordinate the prescription complexity with doctors,especially the dose,frequency,and route of prescription.The medication discrepancy management program was started early after discharge,checking and correcting deviations to reduce the occurrence of ADE.