Hawkey C J, Hodgson S, Norman A, Daneshmend T K, Garner S T
University Hospital, Nottingham.
BMJ. 1990 Apr 14;300(6730):986-90. doi: 10.1136/bmj.300.6730.986.
To evaluate the medical impact of reactive pharmacy intervention.
Analysis of all interventions during 28 days by all 35 pharmacists in hospitals in Nottingham.
All (six) hospitals in the Nottingham health authority (a teaching district), representing 2530 mainly acute beds, 781 mental illness beds, and 633 mainly health care of the elderly beds.
Hospital inpatients and outpatients.
Recording of every important intervention made by pharmacists to prescriptions for both inpatients and outpatients when they perceived inadequacies of drug prescription or administration, including characterisation of the problem, coding of outcome, recording of time taken to initiate and resolve intervention, and grade of prescribing doctor. The problems were independently assessed for their potential to cause medical harm.
769 Interventions (about 2.9% of prescriptions) were made, of which 60 concerned prescriptions rated as having a major potential for medical harm. The commonest problems concerned dosage, which was wrong in 280 prescriptions (102 for antibiotics) and not stated in 50 (one for antibiotics), especially those associated with a major potential for medical harm (32 prescriptions). These concerned sedatives; analgesics; cardiovascular drugs or diuretics; and iron, vitamin, or mineral preparations. Also common were overprolonged prescription of antibiotics (48 prescriptions), confusion of drug names (nine), and inadvertent coprescription of excessive quantities of aspirin or paracetamol in plain and compound preparations (seven). The pharmacist's recommendation was accepted in 639 instances (86%), and the prescription was altered in 575, leading to an appreciable (246 cases) or minor (231 cases) improvement. Interventions had little effect on costs; 427/646 had no effect and 130 produced savings less than 50p. Pharmacy intervention (730/769 interventions) occupied on average 41 minutes per pharmacist per week.
Most reactive pharmacy interventions concerned prescribing errors with a limited potential for medical harm, but a small number of detected errors with a major potential for medical harm; cost savings were not appreciable.
评估反应性药学干预的医疗影响。
对诺丁汉市各医院的35名药剂师在28天内进行的所有干预措施进行分析。
诺丁汉卫生当局（一个教学区）的所有（六所）医院，共有2530张主要用于急症的床位、781张精神疾病床位以及633张主要用于老年保健的床位。
住院患者和门诊患者。
当药剂师察觉到药物处方或用药存在不足时，记录其针对住院患者和门诊患者处方所采取的每一项重要干预措施，包括问题的描述、结果编码、启动和解决干预措施所需时间的记录以及开处方医生的级别。对这些问题导致医疗伤害的可能性进行独立评估。
共进行了769次干预（约占处方总数的2.9%），其中60次涉及被评定为具有重大医疗伤害风险的处方。最常见的问题涉及剂量，280张处方（其中102张为抗生素处方）的剂量有误，50张（其中1张为抗生素处方）未标明剂量，尤其是那些具有重大医疗伤害风险的处方（32张）。这些涉及镇静剂、镇痛药、心血管药物或利尿剂以及铁剂、维生素或矿物质制剂。抗生素处方开具时间过长（48张）、药名混淆（9张）以及普通制剂和复方制剂中无意中同时过量开具阿司匹林或对乙酰氨基酚（7张）也较为常见。药剂师的建议在639例（86%）中被采纳，575张处方被更改，从而带来了明显改善（246例）或轻微改善（231例）。干预措施对成本影响不大；646例中有427例无影响，130例节省的费用不到50便士。药学干预（769次干预中的730次）平均每位药剂师每周耗时41分钟。
大多数反应性药学干预涉及潜在医疗伤害可能性有限的处方错误，但也发现了少数具有重大医疗伤害风险的错误；成本节省并不显著。
