Kennedy Amy K, Gatewood Sharon B S
University of Arizona College of Pharmacy, Tucson, Arizona, USA.
Consult Pharm. 2010 Dec;25(12):829-33. doi: 10.4140/TCP.n.2010.829.
Medication errors continue to cause significant morbidity and mortality. This, in turn, costs the health care system millions of dollars each year in preventable costs. Medication reconciliation, an important piece of medication therapy management (MTM), is vital to reducing medication errors. By verifying, clarifying, and reconciling medications at each point of care, pharmacists can play a vital role in improving health care and lowering costs. This case study describes an MTM session with a 66-year-old Caucasian female who is referred by the nurse practitioner in the clinic for pharmacist services. The patient has a history of portal hypertension, alcoholic liver damage, and chronic obstructive pulmonary disease. After obtaining a detailed history, the pharmacist identified significant medication-related problems including polypharmacy, nonadherence, drug-alcohol interactions, and inappropriate use of medication. After discussions with the patient and her nurse practitioner, a medication plan was created for the patient to follow.
用药错误持续导致严重的发病和死亡。这反过来每年给医疗保健系统造成数百万美元的可预防成本。用药核对作为药物治疗管理（MTM）的重要组成部分，对于减少用药错误至关重要。通过在每个护理环节核实、澄清和核对药物，药剂师在改善医疗保健和降低成本方面可以发挥至关重要的作用。本案例研究描述了一次与一名66岁白人女性的MTM会诊，该女性由诊所的执业护士转介接受药剂师服务。该患者有门静脉高压、酒精性肝损伤和慢性阻塞性肺疾病病史。在获取详细病史后，药剂师识别出了重大的用药相关问题，包括用药过多、不依从、药物与酒精相互作用以及用药不当。在与患者及其执业护士讨论后，为患者制定了一份用药计划以供遵循。
