Pharmacy Department, Trousseau Hospital, Tours University Hospital, 2 bld Tonnellé, 37 044, Tours Cedex, France.
Int J Clin Pharm. 2013 Aug;35(4):656-63. doi: 10.1007/s11096-013-9788-6. Epub 2013 May 18.
To evaluate the non-intentional prescription discrepancies between home medication and hospital medication for in-patients, their potential clinical impact and the impact of pharmaceutical communication between community pharmacists (CP) and hospital clinical pharmacists (HCP) to prevent them.
Prospective study of 278 in-patient's files hospitalized in orthopaedic surgery + units.
After reconciliation by the HCP including patient interviews, GP prescription reviews and CP drug delivery analyses, we analysed patient files (prescription and patient chart) and we compared the administered drugs (home medication) to those that the patient should have received. We tracked the pharmaceutical intervention, the physician acceptance and the identified and avoided errors. The clinical impact of each discrepancy was evaluated by a team composed of a physician and a clinical pharmacist.
Frequency of intentional and non-intentional discrepancy (NID), evaluation of NID clinical impact and rate of NID identified and corrected by the reconciliation procedure.
278 consecutive patients were included in the study. 1,532 prescription lines were analysed and 471 discrepancies were observed [IC95 % = (28.43; 33.00)]. Nonintentional discrepancies (NID) affected 9.2 % of prescription lines [IC95 % = (7.7; 10.6)] and 34.2 % of patients [IC95 % = (31.3; 37.1)]. Fifty-one patients (18.3 %) had at least one NID classified as potentially harmful. Sixty-nine percent of errors at admission were identified by the reconciliation procedure including data exchanges with CP.
This study demonstrates the importance of drug reconciliation at patient's admission by the HCP supported by communication with the CP.
评估住院患者的家庭用药与医院用药之间非故意的处方差异，及其潜在的临床影响，以及社区药剂师（CP）与医院临床药剂师（HCP）之间药物沟通的影响，以预防这些差异。
对 278 名骨科手术+病房住院患者的文件进行前瞻性研究。
HCP 进行包括患者访谈、GP 处方审查和 CP 药物输送分析在内的药物重整后，我们分析了患者文件（处方和患者图表），并将患者应接受的药物与实际给予的药物进行比较。我们追踪了药物干预、医生接受情况以及发现和避免的错误。由一名医生和一名临床药剂师组成的团队评估了每个差异的临床影响。
故意和非故意差异（NID）的频率、NID 临床影响的评估以及通过重整程序识别和纠正的 NID 发生率。
278 名连续患者纳入研究。分析了 1532 条处方线，观察到 471 条差异[95%置信区间（CI）=（28.43；33.00）]。非故意差异（NID）影响了 9.2%的处方线[95%CI=（7.7；10.6）]和 34.2%的患者[95%CI=（31.3；37.1）]。51 名患者（18.3%）至少有一种被认为有潜在危害的 NID。重整程序识别了 69%的入院时的错误，包括与 CP 的信息交换。
这项研究表明，HCP 在 CP 支持下对患者入院时进行药物重整的重要性。
