الفهرس 
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Abstract
Patients have a basic expectation when they receive health care that they will not be harmed in the process. Medical error may or may not cause harm to the patient, if it causes harm it is known as adverse event.Medicines are the most common treatment used in health care and contribute to significant improvements in health when used appropriately. However, medicine use can also be associated with harm. This harm varies from a mild allergic reaction to a drug all the way to death. The most common causes of medication errors are incomplete patients’ information, with the healthcare professionals not knowing about allergies and other medications that patient is using, and miscommunication between physicians, pharmacists and other healthcare professionals.Data on medication errors in Egypt are limited. However, a study conducted to detect medication related problem in a general public hospital in Egypt revealed that the average rate of wrong doses was 2.8% of total doses prescribed. Medication discrepancies are a type of medication error that occurred during transition of care. No studies on medication discrepancies emerged in Egypt, so our study is considered the foundation stone in this area.
The present work aimed at measuring medication discrepancies on admission to and discharge from general internal medicine departments at one general hospital as well measuring the knowledge and attitude of physicians regarding medication safety.
The adult internal medicine patients and their medical record were the target population of our study; 400 patients and their medical records were involved in the study.
The data collection method on admission included concurrent interview with the admitted patients to obtain the best possible medication history, reviewing the admission sheet of the patients to obtain the discrepancies between the home medications and the medications on admission and these discrepancies were reconciled with the prescribing physicians to differentiate the discrepancies into intended and unintended.
On discharge, the last 24 hours medications were compared with the discharge prescribing medications to obtain the discrepancies that were reconciled with the attending physicians to differentiate the discrepancies into intended and unintended.
Face to face interview with the physicians was used to obtain their responses regarding their knowledge and attitudes towards general patient safety and medication discrepancies.
The present study uncovered the following results:
A- Unintended medication discrepancies:
- The medication history is the cornerstone of medication reconciliation.
- Medication discrepancies are more on admission versus discharge (20.9% versus 11.6%, respectively).
- Patients with unintended medication discrepancies on admission are more than on discharge (45.3% versus 28.2%, respectively)
- Omission is the most common error type on admission while, commission is the most common error type on discharge.
- The gender is a predictor variable for medication discrepancies on admission (p=0.01) although, it is not significant on discharge (p=0.735)
- Females have experienced medication discrepancies more than males on admission while, males have experienced medication discrepancies more than females on discharge.
- The age is a predictor variable on admission (p=0.001) but not on discharge (p=0.271).
- The age group 20-˂40 years has experienced the greatest medication discrepancies on admission while, the age group 40-˂60 years has experienced the greatest medication discrepancies on discharge.
- Complexity of case is a predictor variable on admission (p=0.001) but not on discharge (p=0.670).
- Patients with multiple diagnoses have more medication discrepancies on admission than patients with one diagnosis while, patients with one diagnosis have more discrepancies more on discharge.
- Length of stay is not a predictor for medication discrepancies (p=0.145).
- Physicians’ job level is a predictor variable for medication discrepancies (p=0.001). Specialists are the most common physicians who committed medication discrepancies, being 59.1%
- The most common drug category involved in medication discrepancies on admission is hormones while, cholesterol lowering drug is the commonest drug involved in discrepancies on discharge.
- Dose error is the most common medication error on admission while, strength error is the commonest on discharge.
B- Physicians’ knowledge and attitude towards general patient safety and medications errors:
- Physicians’ attitudes towards general patient safety are neutral.
- Physicians’ attitudes towards medical error are neutral with statistical significance between female and male (p=0.02).
- Physicians’ attitudes towards medication error are neutral. There is a statistical significance with the level of education(p=0.01) and also with the years of services (p=0.017)
- Physicians’ attitudes towards medication discrepancies and reconciliation are favorable (3.6).
- Nearly half of physicians (52.8%) thought admission as the most likely point of transition to be involved in medication discrepancies.
- Nurses are more contributing to medication error according to 45.3 % of physicians’ responses.
In the view of this work results the suggested recommendations were:
1- The physicians should be trained on patient safety and medication reconciliation and if possible this field should be involved in the undergraduate curriculums.
2- Electronic medical record should be applied to ensure a best possible medication history.
3- The hospital quality department should formulate a root cause analysis to identify the main causes of the discrepancies to ameliorate them.
4- The physicians should carefully take the medication history especially from the females by more than one way as the females are the gender who experienced most of the medications discrepancies.
5- During the patients’ stay at hospital, the medication should be reviewed in a systematic manner to detect any discrepancy before reaching the patient or causing harm.
6- Patient centered care principle should be implemented to involve the patient in the management process.
7- Patient education about the medication errors and discrepancies to illustrate the importance of medication history.
8- Clinical pharmacy department should be activated to conduct the reconciliation process and review the medication sheet.
9- Further researches are required:
- On inpatients from different administrative authorities and different departments.
- A similar study can be conducted with involving the seriousness of the medication errors.
- Using multi-disciplinary research team including clinical pharmacy to decrease errors and biases as they are more knowledge and experienced regarding medications.