Marotti S B, Kerridge R K, Grimer M D
Perioperative Service, John Hunter Hospital, Newcastle, New South Wales, Australia.
Anaesth Intensive Care. 2011 Nov;39(6):1064-70. doi: 10.1177/0310057X1103900613.
Errors in the management of regular medications at the time of hospital admission are common. This randomised controlled three-arm parallel-group trial examined the impact of pharmacist medication history taking and pharmacist supplementary prescribing on unintentional omissions of postoperative medications in a large perioperative service. Participants included elective surgical patients taking regular medications with a postoperative hospital stay of one night or more. Patients were randomly assigned, on admission, to usual care (n=120), a pharmacist medication history only (n=120) or pharmacist medication history and supplementary prescribing (n=120). A medication history involved the pharmacist interviewing the patient preoperatively and documenting a medication history in the medical record. In the supplementary prescribing group the patients' regular medicines were also prescribed on the inpatient medication chart by the pharmacist, so that dosing could proceed as soon as possible after surgery without the need to wait for medical review. The estimate marginal mean number of missed doses during a patients hospital stay was 1.07 in the pharmacist supplementary prescribing group, which was significantly less than both the pharmacist history group (3.30) and the control group (3.21) (P < 0.001). The number of medications charted at an incorrect dose or frequency was significantly reduced in the pharmacist history group and further reduced in the prescribing group (P < 0.001). We conclude that many patients miss doses of regular medication during their hospital stay and preoperative medication history taking and supplementary prescribing by a pharmacist can reduce this.
入院时常规药物管理中的错误很常见。这项随机对照三臂平行组试验，研究了药剂师采集用药史和药剂师补充开方，对大型围手术期服务中术后药物无意遗漏的影响。参与者包括服用常规药物、术后需住院一晚或更长时间的择期手术患者。患者入院时被随机分配到常规护理组（n = 120）、仅由药剂师采集用药史组（n = 120）或药剂师采集用药史并补充开方组（n = 120）。采集用药史包括药剂师在术前询问患者，并在病历中记录用药史。在补充开方组，药剂师还会在住院用药清单上为患者开出常规药物，以便术后能尽快给药，无需等待医生复查。药剂师补充开方组患者住院期间漏服药物剂量的估计边际均值为1.07，显著低于药剂师采集用药史组（3.30）和对照组（3.21）（P < 0.001）。药剂师采集用药史组中，以错误剂量或频率开列的药物数量显著减少，而在补充开方组进一步减少（P < 0.001）。我们得出结论，许多患者在住院期间会漏服常规药物，术前药剂师采集用药史和补充开方可减少这种情况。
