gms | German Medical Science

Objective: A marked increase in spinal surgery in recent years prompted a debate on quality issues. Besides surgical issues, several other factors influence overall outcome. We investigated medication errors in spinal-instrumentation patients and applied current medication reconciliation strategies.

Method: In 2011 all patients receiving spinal instrumentation were included in a survey on medication safety. Risk-factors were prioritized according to their frequency and severity. In 2012 specific counter-measures were introduced and results were re-evaluated in 2013.

Results: 147 patients were included in the 2011 and additional 162 in the 2013 survey. We identified 3 problematic processes which were targeted by specific counter-measures: Correct timing of withdrawl of anticoagulants and antidiabetics, assessment of medication history, and prescription of postoperative analgetics and anticoagulants. Specific counter-measures included standardization of drug preparations, doses and prescription-process; improved access to information (via online-documentation-system and smartphone application) and increasing patient-awareness by the use of flyers and informative posters.

2011 vs. 2013 the rate of elective patients admitted under anticoagulation/antidiabetics not withdrawn as scheduled dropped from 18 to 0%. In 2011 cumulative delay of surgery due to this problem amounted to 11d (causing net costs of approximately 10.000 €) while, no elective patient had to be postponed because of failed medication withdrawl in 2013. The rate of complete substitution of prescriptions by preparations listed in the hospital was raised from 29 to 46%, reducing the costs for not substituted medication from 2.63 to 0.43 € per patient and day. The rate of correctly continued home medication was raised from 65 to 79%. The rate of double prescriptions of postoperative analgetics could be dropped from 33 to 0%; while the rate of correct prescriptions for postoperative base- and on-demand analgetics was raised from 94 to 100% resp. from 54 to 100%. Costs for analgetics dropped from 0.17 to 0.12 € per patient and day. The rate of optimal postoperative anticoagulant prescriptions could be raised from 54 to 80%. Costs for anticoagulants dropped from 0.22 to 0.16 € per patient and day.

Conclusions: In 2011 the incidence of medication errors was found surprisingly high. Medication safety could be dramatically improved by implementation of counter-measures specific to the identified risk-factors.