Laboratory ThEMAS TIMC UMR CNRS, Joseph Fourier University Grenoble, France.
Acta Anaesthesiol Scand. 2012 Sep;56(8):1047-51. doi: 10.1111/j.1399-6576.2011.02644.x. Epub 2012 Jan 31.
Clinical pharmacists can help prevent medication errors. However, data are scarce on their role in preventing medication prescription errors in the post-operative period, a high-risk period, as at least two prescribers can intervene, the surgeon and the anesthetist. We aimed to describe and quantify clinical pharmacist' intervention (PIs) during validation of drug prescriptions on a computerized physician order entry system in a post-surgical and post-transplantation ward. We illustrate these interventions, focusing on one clearly identified recurrent problem.
In a prospective study lasting 4 years, we recorded drug-related problems (DRPs) detected by pharmacists and whether the physician accepted the PI when prescription modification was suggested.
Among 7005 orders, 1975 DRPs were detected. The frequency of PIs remained constant throughout the study period, with 921 PIs (47%) accepted, 383 (19%) refused and 671 (34%) not assessable. The most frequent DRP concerned improper administration mode (26%), drug interactions (21%) and overdosage (20%). These resulted in a change in the method of administration (25%), dose adjustment (24%) and drug discontinuation (23%) with 307 drugs being concerned by at least one PI. Paracetamol was involved in 26% of overdosage PIs. Erythromycin as prokinetic agent, presented a recurrent risk of potentially severe drug-drug interactions especially with other QT interval-prolonging drugs. Following an educational seminar targeting this problem, the rate of acceptation of PI concerning this DRP increased.
Pharmacists detected many prescription errors that may have clinical implications and could be the basis for educational measures.
临床药师可以帮助预防用药错误。然而，在术后这个高风险时期，数据对于药师在预防用药医嘱错误方面的作用却很有限，因为至少有两个医嘱开具者（外科医生和麻醉师）会进行干预。我们旨在描述并量化临床药师在术后和移植病房的计算机化医嘱录入系统中验证药物处方时的干预（PI）。我们举例说明了这些干预措施，重点关注一个明确的反复出现的问题。
在一项持续 4 年的前瞻性研究中，我们记录了药师发现的药物相关问题（DRP），并在建议修改医嘱时，记录了医生是否接受 PI。
在 7005 条医嘱中，发现了 1975 个 DRP。整个研究期间，PI 的频率保持不变，其中 921 个（47%）被接受，383 个（19%）被拒绝，671 个（34%）无法评估。最常见的 DRP 涉及给药方式不当（26%）、药物相互作用（21%）和用药过量（20%）。这导致给药方式改变（25%）、剂量调整（24%）和药物停用（23%），涉及至少一种 PI 的 307 种药物。扑热息痛超量的 PI 占 26%。红霉素作为促动力剂，存在潜在的严重药物相互作用风险，特别是与其他延长 QT 间期的药物。针对这一问题举办教育研讨会后，针对这一 DRP 的 PI 接受率有所提高。
药师发现了许多可能具有临床意义的处方错误，并可以作为教育措施的基础。
