Bedouch P, Allenet B, Grass A, Labarère J, Brudieu E, Bosson J-L, Calop J
Pôle pharmacie, Centre Hospitalier-Universitaire de Grenoble, Grenoble, France.
J Clin Pharm Ther. 2009 Apr;34(2):187-95. doi: 10.1111/j.1365-2710.2008.00990.x.
Identification and estimation, by clinical pharmacists participating in routine medical rounds, of drug-related problems (DRPs), arising despite the use of a computerized physician order entry (CPOE) system.
An 18-month prospective study of DRPs through a CPOE was conducted by seven clinical pharmacists participating in ward activity. DRPs were identified by two independent pharmacists using a structured order review (French Society of Clinical Pharmacy instrument).
A total of 29 016 medication orders relating to 8152 patients were analysed, and 2669 DRPs, involving 1564 patients (56% female; mean age 72.6 years), were identified representing 33 DRPs per 100 admissions. The most commonly identified DRPs were non-conformity to guidelines or contra-indication (29.5%), improper administration (19.6%), drug interaction (16.7%) and overdosage (12.8%). There were 429 different drugs associated with these DRPs. Cardiovascular drugs were the most frequently implicated (22.2%), followed by antibiotics/anti-infectives (13.3%) and analgesics/antiinflammatory drugs (11.3%). Different types of DRPs were closely associated with specific classes of drugs.
Drug-related problems are common even after implementation of CPOE. In this context, routine participation of clinical pharmacists in clinical medical rounds may facilitate identification of DRPs. Pharmacists should be able to enhance patient safety through such involvement.
由参与日常医疗查房的临床药师识别和评估尽管使用了计算机化医嘱录入（CPOE）系统仍出现的药物相关问题（DRP）。
7名参与病房活动的临床药师通过CPOE对DRP进行了为期18个月的前瞻性研究。由两名独立的药师使用结构化医嘱审查（法国临床药学协会工具）来识别DRP。
共分析了与8152名患者相关的29016条用药医嘱，识别出2669个DRP，涉及1564名患者（56%为女性；平均年龄72.6岁），每100例入院患者中有33个DRP。最常识别出的DRP是不符合指南或存在禁忌（29.5%）、用药不当（19.6%）、药物相互作用（16.7%）和用药过量（12.8%）。与这些DRP相关的有429种不同药物。心血管药物最常涉及（22.2%），其次是抗生素/抗感染药（13.3%）和镇痛药/抗炎药（11.3%）。不同类型的DRP与特定类别的药物密切相关。
即使实施了CPOE，药物相关问题仍很常见。在这种情况下，临床药师日常参与临床医疗查房可能有助于识别DRP。药师应能够通过这种参与提高患者安全性。
