Pharmacy Department, Grenoble University Hospital, Grenoble, France.
J Eval Clin Pract. 2012 Aug;18(4):911-8. doi: 10.1111/j.1365-2753.2011.01704.x. Epub 2011 Jun 20.
RATIONALE, AIMS AND OBJECTIVES: To analyse pharmacists' interventions in a setting where a computerized physician order entry system (CPOE) is in use and a pharmacist works on the ward.
A prospective cohort study was conducted in seven wards of a French teaching hospital using CPOE along with the presence of a full-time on-ward pharmacy resident. We documented the characteristics of pharmacists' interventions communicated to physicians during the medication order validation process whenever a drug-related problem was identified. Independent predictors of the physician's acceptance of the pharmacist's intervention were assessed using multiple logistic regression analysis.
The 448 pharmacists' interventions concerned: non-conformity to guidelines or contraindications (22%), too high doses (19%), drug interactions (15%) and improper administration (15%). The interventions consisted of changes in drug choice (41%), dose adjustment (23%), drug monitoring (19%) and optimization of administration (17%). Interventions were communicated via the CPOE in 57% of cases and 43% orally. The rate of physicians' acceptance was 79.2%. In multivariate analysis, acceptance was significantly associated with the physician's status [higher for residents vs. seniors: OR = 7.23, CI 95 (2.37-22.10), P < 0.01], method of communication [higher for oral vs. computer communication: OR = 12.5, CI 95 (4.16-37.57), P < 0.01] and type of recommendation [higher for drug monitoring vs. drug choice recommendations: OR = 10.32, CI 95 (3.20-33.29), P < 0.01].
When a clinical pharmacist is present on a ward in which a CPOE is in use, the pharmacists' interventions are well accepted by physicians. Specific predictors of the acceptance by physicians emerge, but further research as to the impact of CPOE on pharmacist-physician communication is needed.
背景、目的和目标：分析在使用计算机化医嘱录入系统（CPOE）且有药师在病房工作的环境中，药师的干预措施。
在法国一所教学医院的 7 个病房进行了一项前瞻性队列研究，使用 CPOE 并配备全职病房药房驻院药师。每当发现药物相关问题时，我们记录药师在药物医嘱核对过程中向医师传达的干预措施的特征。使用多因素逻辑回归分析评估医师接受药师干预的独立预测因素。
448 次药师干预措施涉及：不符合指南或禁忌（22%）、剂量过高（19%）、药物相互作用（15%）和给药不当（15%）。干预措施包括药物选择改变（41%）、剂量调整（23%）、药物监测（19%）和给药优化（17%）。干预措施通过 CPOE 传达的占 57%，口头传达的占 43%。医师接受率为 79.2%。多因素分析显示，接受程度与医师身份显著相关[住院医师 vs. 主治医生更高：比值比（OR）=7.23，95%置信区间（CI）（2.37-22.10），P<0.01]、沟通方式[口头沟通 vs. 计算机沟通更高：OR=12.5，95%CI（4.16-37.57），P<0.01]和推荐类型[药物监测建议 vs. 药物选择建议更高：OR=10.32，95%CI（3.20-33.29），P<0.01]。
当 CPOE 在配备有临床药师的病房中使用时，医师会很好地接受药师的干预措施。医师接受干预的具体预测因素已经显现，但需要进一步研究 CPOE 对药师-医师沟通的影响。
