Jellinek Samantha P, Cohen Victor, Fancher Lydia B, Likourezos Antonios, Lyke Mary, Peterson Kathy, Lashley Eustace, Davidson Steven J
Department of Pharmaceutical Services, Maimonides Medical Center, 4802 Tenth Ave, Brooklyn, NY 11219, USA.
J Emerg Nurs. 2010 Mar;36(2):105-10. doi: 10.1016/j.jen.2009.03.010. Epub 2009 Jun 4.
Our purpose was to assess the variations in timely administration of medications based on differences in nursing staff (ED nurses who are responsible for emergency and boarded patients vs inpatient nurses who are responsible for only boarded patients) and to determine whether a pharmacist's interventions can improve the timely administration of medications to boarded patients in the emergency department.
This was a prospective observational study. Patients were included in the study if they were aged 18 years or older, were physically located in the emergency department but had already been admitted to the medical center, and had medication orders. The pharmacist documented the medication orders and the allotted time for administration. Once the upper limit of the allotted time frame for administration had passed, the pharmacist determined whether the medications were given and interventions were then carried out for those medications that were not administered. Successful interventions were documented when the medication was given within 1 hour from the time of intervention.
Seventy-nine patients were included in the study, resulting in 266 medication administration opportunities (emergency department, 146; inpatient, 120). Inpatient nurses administered medications in a timely manner at a significantly greater rate than ED nurses (83.3% vs 63.7%, P < .0001). The greatest difference was observed during the evening hours (95.2% vs 53.8% of medications administered for inpatient vs ED nurses, P = .002). The most common reason for medications not being administered by ED nurses was insufficient time (51.4%), and for inpatient nurses, it was that the medication order was not verified (77.8%). The pharmacist's interventions were successful with both the ED and inpatient nurses (95.5% and 94.1%, respectively).
This study illustrates that assigning nurses with varying workloads as a means to manage overcrowding is likely to result in boarded patients in the emergency department not receiving their medications. ED pharmacists' interventions may fill the gap, ensuring compliance with the administration of medication orders prescribed for boarded patients and ensuring more timely administration. A multidisciplinary team approach is needed to manage current overcrowding issues.
我们的目的是根据护理人员的差异（负责急诊患者和待住院患者的急诊科护士与仅负责待住院患者的住院部护士）评估药物及时给药情况的差异，并确定药剂师的干预措施是否能改善急诊科待住院患者的药物及时给药情况。
这是一项前瞻性观察研究。年龄在18岁及以上、身处急诊科但已被收治入医疗中心且有用药医嘱的患者被纳入研究。药剂师记录用药医嘱及给药的规定时间。一旦规定给药时间框架的上限已过，药剂师确定药物是否已给药，然后对未给药的药物进行干预。当药物在干预后1小时内给药时，记录为成功干预。
79名患者被纳入研究，产生了266次给药机会（急诊科146次，住院部120次）。住院部护士给药及时率显著高于急诊科护士（83.3%对63.7%，P<.0001）。在夜间观察到的差异最大（住院部护士给药的药物占95.2%，急诊科护士给药的药物占53.8%，P=.002）。急诊科护士未给药的最常见原因是时间不足（51.4%），而住院部护士未给药的最常见原因是用药医嘱未核实（77.8%）。药剂师对急诊科和住院部护士的干预均取得成功（分别为95.5%和94.1%）。
本研究表明，将工作量不同的护士分配到不同岗位以应对过度拥挤的情况，可能会导致急诊科的待住院患者无法按时服药。急诊科药剂师的干预可能会填补这一空白，确保遵守为待住院患者开出的用药医嘱，并确保更及时地给药。需要采取多学科团队方法来管理当前的过度拥挤问题。
