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Hospital medication errors more likely in type 1 vs. type 2 diabetes

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October 25, 2017

At hospital admission, patients with type 1 diabetes have an approximately twofold higher risk for medication errors than those with type 2 diabetes, including a much greater frequency of errors involving wrongly added medications, according to findings published in Diabetic Medicine.

To improve medication safety and decrease errors, several institutions have recommended “medication reconciliation” at all transition points, which includes comparing a complete and correct list of a patient’s current medications with prescriptions at the different steps of hospitalization, Cyril Breuker, MD, of the clinical pharmacy department at University Hospital Montpellier, France, and colleagues wrote in the study background.

“As the number of medications is often a risk factor for medication errors, it is likely that people with chronic diseases like diabetes are at increased risk for these errors,” Breuker and colleagues wrote. “Indeed, we have already demonstrated that people with diabetes do have a higher risk of medication error than those without diabetes. Further, because individuals with type 1 and type 2 diabetes have different clinical characteristics, it seems important to compare prescribing errors between these two groups.”

Researchers analyzed prospective data from 671 adults with type 1 (24.3%) or type 2 diabetes (75.7%) admitted to the diabetology department of the University Hospital of Montpellier between November 2013 and May 2015 and followed until discharge. The hospital follows a validated medication reconciliation protocol within 24 hours of admission with a pharmacy team, including a senior pharmacist, one resident and two pharmacy students, and follows the same procedure again at discharge.

“Pharmacists and physicians discussed each [medication] discrepancy between the medication history and the hospitalization prescription to determine whether it was intentional or unintentional,” the researchers wrote. “Unintentional medication discrepancies corrected by the physician were considered medication errors.”

For each medication error, researchers documented the drug class and potential clinical impact for the patient (very serious, serious, moderate and minor), and used logistic regression analysis to assess the relationship between the type of diabetes and risk for medication errors.

Overall, researchers found that 197 patients (29.4%) had at least one medication error detected at admission or discharge. In both groups, at both admission and discharge, omissions were the first cause of medication errors (59.6%).

At admission, researchers observed a higher percentage of overall medication errors among patients with type 1 vs. type 2 diabetes, with a median error rate of 16.7% vs. 12.5% (P = .02). However, when looking specifically at cardiovascular drugs, researchers found patients with type 2 diabetes had more medication errors vs. patients with type 1 (38.6% vs. 19.3%; P < .01). Additionally, a trend toward more medication errors involving drugs used for diabetes management was observed on admission in people with type 1 compared with type 2 diabetes (17.9% vs. 9.3%; P = .08).

The error of wrongly added medications occurred more frequently in patients with type 1 vs. type 2 diabetes (12.5% vs. 1.2%; P < .001); however, errors of wrong administration frequency or dose were observed more often in patients with type 2 vs. type 1 diabetes (41.5% vs. 26.8%; P < .05).

At both admission and discharge, researchers did not observe between-group differences for the severity of medication errors, with 37% of errors considered serious or very serious overall.

“Several hypotheses could explain this result,” the researchers wrote. “First, people with type 1 diabetes were more often admitted as an emergency. Second, higher medication errors involving added medications and drugs used for diabetes management were observed in people with type 1 than in those with type 2 diabetes. Lastly, the percentage of medication errors per treatment was significantly higher in the type 1 diabetes population at admission.”

The researchers noted that clinical pharmacists should focus on at-risk populations, such as patients prescribed many medications, but also high-risk groups, such as patients with type 1 diabetes. – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.