Bond C A, Raehl Cynthia L
Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas 79106, USA.
Pharmacotherapy. 2008 Jan;28(1):1-13. doi: 10.1592/phco.28.1.1.
To determine the extent of 15 hospital-based clinical pharmacy services, 51 different drugs managed under protocol by pharmacists, medication errors, and pharmacy technology in United States hospitals.
A survey was mailed, as well as sent electronically, to pharmacists in 2893 hospitals.
A total of 1125 surveys were returned (38.9% response rate). The 1125 hospitals had 14,315,506 patients admitted, which represented 45.7% of the 31,324,496 admissions to all U.S. hospitals in 2006. The proportion of clinical pharmacy services provided by Veterans Affairs (VA) hospitals was higher compared with non-VA hospitals. In all hospitals, the clinical pharmacy services with the greatest growth from 1989-2006 were pharmacist-provided admission drug histories (300% increase), pharmacist participation on medical rounds (292.3% increase), drug protocol management (208% increase), pharmacist-conducted clinical research (166.7% increase), pharmacist-provided drug information (150% increase), and pharmacist-provided pharmacokinetic consultation (117.5% increase). A total of 864 hospitals (76.8%) had pharmacists providing drug protocol management (collaborative drug management). Pharmacists managed a mean +/- SD of 9.18 +/- 10.23 different drugs/hospital (7932 protocols). Drugs commonly managed included aminoglycosides (64.4% of hospitals), vancomycin (63.8%), warfarin (37.8%), low-molecular-weight heparins (32.7%), unfractionated heparin (30.0%), fluoroquinolones (30.0%), antiparkinsonian drugs (22.8%), proton pump inhibitors (22.7%), human immunodeficiency virus drugs (21.9%), and cephalosporins (19.7%). The mean number of medication errors reported/hospital increased by 151.4% between 1995 and 2006. The percentage of patients who experienced a medication error increased from 4.7% to 6.5% between 1995 and 2006 (a 38.3% increase). A total of 220 hospitals (19.6%) had computerized prescriber order entry systems, 263 (23.4%) had bar coding for drug administration, and 439 (39.0%) used robotics for dispensing.
This study provides continuing evidence of the growth and value of clinical pharmacy services and clinical pharmacists in our nation's hospitals. These data will guide hospital pharmacy directors and clinical coordinators in allocating resources to optimally meet their patients' needs.
确定美国医院中15项基于医院的临床药学服务的范围、药剂师依据方案管理的51种不同药物、用药差错以及药学技术的情况。
向2893家医院的药剂师邮寄并通过电子方式发送了一份调查问卷。
共收到1125份调查问卷（回复率为38.9%）。这1125家医院收治了14315506名患者，占2006年美国所有医院31324496例入院患者的45.7%。与非退伍军人事务（VA）医院相比，VA医院提供的临床药学服务比例更高。在所有医院中，1989 - 2006年增长幅度最大的临床药学服务包括药剂师提供入院药物史（增长300%）、药剂师参与医疗查房（增长292.3%）、药物方案管理（增长208%）、药剂师开展临床研究（增长166.7%）、药剂师提供药物信息（增长150%）以及药剂师提供药代动力学咨询（增长117.5%）。共有864家医院（76.8%）有药剂师进行药物方案管理（协作药物管理）。药剂师平均每家医院管理9.18 ± 10.23种不同药物（7932个方案）。常见管理的药物包括氨基糖苷类（64.4%的医院）、万古霉素（63.8%）、华法林（37.8%）、低分子肝素（32.7%）、普通肝素（30.0%）、氟喹诺酮类（30.0%）、抗帕金森药物（22.8%）、质子泵抑制剂（22.7%）、人类免疫缺陷病毒药物（21.9%）以及头孢菌素（19.7%）。1995年至2006年间，每家医院报告的用药差错平均数量增加了151.4%。1995年至2006年间，经历用药差错的患者比例从4.7%增至6.5%（增长38.3%）。共有220家医院（19.6%）拥有计算机化医嘱录入系统，263家（23.4%）有药物给药条形码，439家（39.0%）使用机器人进行调配。
本研究持续证明了临床药学服务及临床药师在我国医院中的发展和价值。这些数据将指导医院药房主任和临床协调员分配资源，以最佳地满足患者需求。
