R&D department, National Corporation of Swedish Pharmacies (Apoteket AB), Apoteket Lejonet, Stortorget 8, SE-211 34 Malmö, Sweden.
Res Social Adm Pharm. 2010 Sep;6(3):174-84. doi: 10.1016/j.sapharm.2009.09.001. Epub 2009 Oct 30.
Pharmacists have an important role in detecting, preventing, and solving prescription problems, which if left unresolved, may pose a risk of harming the patient.
The aim was to examine prescription problems detected at pharmacies in Sweden, where pharmacists consider it necessary to contact the prescribers for clarification, completion or correction of the prescriptions before dispensing, and to compare the intervention rates at public pharmacies at hospitals (PPHs) with those at city center pharmacies (CCPs).
All attempts to contact the prescriber about a prescription problem were recorded by trained observers (pharmacy students). Analyses were made of overall distribution of problem prescriptions, including data from all 14 participating pharmacies, and a comparison between CCPs and PPHs with data from the 5 areas, each consisting of 1 CCP and 1 PPH (10 pharmacies). Chi-square-analyses were used to compare proportions, Spearman's rank-correlation coefficient was used to test correlation between recorded rates and dispensed volume, and Wilcoxon two-sample test was used to test differences between the CCPs and PPHs. P<.05 is regarded as statistically significant.
The pharmacists contacted the prescribers for 1% of all new prescriptions before dispensing. Errors that may compromise patient safety and medication outcome constituted almost 60% of the problems. However, there was an inverse correlation between the intervention rates and the pharmacy's dispensing volume. Significantly lower rates of problem prescriptions were recorded for women than for men. The highest rates were seen for prescriptions to patients younger than 15 years, and the rates decreased with increasing patient age. Pharmacists at PPHs contacted the prescribers about prescription problems twice as often as those at large CCPs. Pharmacists spent an average of 5 minutes on the telephone to solve the problem (median time), but 25% of the prescriptions took 10 minutes or more.
Computerized physician order entry (CPOE) and electronically transmitted prescriptions (ETP) can not only reduce the total rate of prescription problems, but also introduce new clinically important errors that may compromise patient safety and medication outcome. The prescription problem rates in the present study differed across prescriber groups and patient age and gender, and the inverse correlation to pharmacy size indicates that all problems are not revealed and corrected and may thus reach the patient. CPOE and ETP have been used extensively in Sweden for the past decade, but the present study indicates that there is still a potential and need for improvement for the vision of "no prescribing errors/problems will reach the patient" to come true.
药剂师在发现、预防和解决处方问题方面发挥着重要作用，如果这些问题得不到解决，可能会对患者造成伤害。
本研究旨在调查瑞典各药房发现的处方问题，药剂师认为在发药前有必要联系处方医生，以澄清、完成或纠正处方。并比较医院内的公共药房（PPH）与市中心药房（CCP）的干预率。
训练有素的观察者（药学学生）记录了所有试图联系处方医生的情况。对所有 14 家参与药房的问题处方总体分布情况进行了分析，还对由 5 个区域组成的每个区域内的 1 家 CCP 和 1 家 PPH（共 10 家药房）的数据进行了比较。采用卡方检验比较比例，采用斯皮尔曼等级相关系数检验记录的干预率与配药量之间的相关性，采用 Wilcoxon 两样本检验比较 CCP 和 PPH 之间的差异。P<.05 被认为具有统计学意义。
在发药前，药剂师对 1%的新处方联系了处方医生。可能危及患者安全和药物疗效的错误占问题处方的近 60%。然而，干预率与药房配药量之间存在负相关。女性记录的问题处方率明显低于男性。15 岁以下患者的处方率最高，随着患者年龄的增长而降低。PPH 药房的药剂师联系处方医生解决处方问题的次数是大型 CCP 药房的两倍。药剂师平均花费 5 分钟（中位数时间）打电话解决问题，但 25%的处方需要 10 分钟或更长时间。
计算机化医嘱录入（CPOE）和电子传输处方（ETP）不仅可以降低处方问题的总发生率，还会引入可能危及患者安全和药物疗效的新的临床重要错误。本研究中的处方问题率因开方医生群体、患者年龄和性别而异，与药房规模的负相关表明，并非所有问题都被发现和纠正，因此可能会送达患者。CPOE 和 ETP 在瑞典已经广泛使用了十年，但本研究表明，为了实现“没有处方错误/问题会送达患者”的愿景，仍有改进的空间和需求。
