title: Patients with diabetes are at high risk of serious medication errors at hospital: Interest of clinical pharmacist intervention to improve healthcare.
abstract: BACKGROUND
  Medication errors (ME) are major public health issues in hospitals because of their consequences on patients' morbi-mortality. This study aims to evaluate the prevalence of ME at admission and discharge of hospitalization in diabetic and non-diabetic patients, and determine their potential clinical impact.
  
  
  METHODS
  This prospective observational study was conducted at the Endocrinology-Diabetology-Nutrition Department. All adult patients admitted were eligible. A total of 904 patients were included, of which 671 (74.2%) with diabetes mellitus. Clinical pharmacists conducted medication reconciliation: they collected the Best Possible Medication History and then compared it with admission and discharge prescriptions to identify medication discrepancies. ME were defined as unintended medication discrepancies if corrected by the physician.
  
  
  RESULTS
  Clinical pharmacists allowed correcting ME in 176/904 (19.5%) patients at admission and in 86/865 (9.9%) patients at discharge. More than half of ME were omissions. Diabetic patients were more affected by ME than non-diabetic patients, both at admission (22.1% vs 12.0%, p<0.001) and at discharge (11.4% vs 5.7%, p=0.01). The diabetic group also had more potentially severe and very severe ME. Diabetic patients had on average twice more medications than non-diabetic patients (8.7±4.5 vs 4.4±3.4, p<0.001). The polypharmacy associated with diabetes, but not diabetes mellitus itself, was identified as a risk factor of ME.
  
  
  CONCLUSIONS
  The intervention of clinical pharmacists allowed correcting 378 ME in 25.8% of the cohort before they caused harm. Clinicians, pharmacists and other health care providers should therefore work together to improve patients' safety, in particular in high-risk patients such as diabetic patients.
authors.affiliation: Clinical Pharmacy Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 371 Avenue du Doyen G. Giraud, 34295 Montpellier, France. Electronic address: c-breuker@chu-montpellier.fr.
authors.forename: Cyril
authors.initials: C
authors.lastname: Breuker
authors.affiliation: Clinical Pharmacy Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France.
authors.forename: Océane
authors.initials: O
authors.lastname: Abraham
authors.affiliation: Clinical Pharmacy Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France.
authors.forename: Laura
authors.initials: L
authors.lastname: di Trapanie
authors.affiliation: Clinical Research and Epidemiology Unit, University Hospital, 39 Avenue Charles Flahault, 34295 Montpellier, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Mura
authors.affiliation: Clinical Research and Epidemiology Unit, University Hospital, 39 Avenue Charles Flahault, 34295 Montpellier, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Macioce
authors.affiliation: Endocrinology-Diabetology-Nutrition Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Boegner
authors.affiliation: Clinical Pharmacy Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Jalabert
authors.affiliation: Clinical Pharmacy Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Villiet
authors.affiliation: Clinical Pharmacy Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Castet-Nicolas
authors.affiliation: PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 371 Avenue du Doyen G. Giraud, 34295 Montpellier, France; Endocrinology-Diabetology-Nutrition Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Avignon
authors.affiliation: PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 371 Avenue du Doyen G. Giraud, 34295 Montpellier, France; Endocrinology-Diabetology-Nutrition Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France.
authors.forename: Ariane
authors.initials: A
authors.lastname: Sultan
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D005602:France; D006801:Humans; D016015:Logistic Models; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D059065:Medication Reconciliation; D008875:Middle Aged; D015999:Multivariate Analysis; D010343:Patient Admission; D010351:Patient Discharge; D061214:Patient Safety; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000592:standards*; D019338:Polypharmacy; D011446:Prospective Studies; D012307:Risk Factors
keywords: Diabetes mellitus; Medication errors; Medication reconciliation; Pharmaceutical care; Safety