David M. Scott, M.P.H., Ph.D., B.S.Pharm., is Professor; Daniel L. Friesner, Ph.D., is Professor and Associate Dean of Student Affairs and Faculty Development; and Ann M. Rathke, M.A., M.Ed., is Co-ordinator, North Dakota Telepharmacy Project, College of Pharmacy, Nursing, and Allied Sciences, North Dakota State University, Fargo. Shelley Doherty-Johnsen, B.S.Pharm., is Director, ePharmacist Direct, Catholic Health Initiatives, Fargo.
Am J Health Syst Pharm. 2014 Jan 1;71(1):58-67. doi: 10.2146/ajhp120533.
Results of a study of medication "quality-related events" (QREs) at critical access hospitals (CAHs) participating in a telepharmacy project are reported.
Rates and types of medication QREs (i.e., all types of drug therapy problems requiring pharmacist intervention) were evaluated at 17 CAHs receiving telepharmacy services from a central order-entry site in the North Dakota Telepharmacy Project (NDTP). During the 17-month study, remote pharmacists used telepharmacy technology to review medication orders prepared at the CAH sites, identify and address QREs, and code clinical interventions. The collected data were analyzed via chi-square testing.
Cumulative monthly medication orders at the CAH study sites ranged from a low of 12,535 in the first month of the study to a high of 18,257. Monthly rates of visual medication verification and clinical intervention ranged from 8.0% to 14.2% and from 1.3% to 3.1%, respectively. Overall, the most frequently identified QREs were transcription errors, which accounted for 2,389 interventions (43.3%); 2,078 interventions (37.7%) targeted prescribing-related QREs. The most frequently cited intervention codes were for dosage adjustments (n = 547), deep venous thrombosis prophylaxis (n = 437), pharmacokinetic consultation (n = 268), renal dosing (n = 182), and the prevention of minor (n = 148) and major (n = 94) adverse drug events.
The study results indicate that the NDTP telepharmacy model is effective in identifying and resolving QREs in CAHs. The use of the telepharmacy services increased over the study period, suggesting that CAH practitioners became more comfortable using the technology on a regular basis to enhance patient safety.
报告参与远程药学项目的基层医疗机构（CAH）药物“质量相关事件”（QRE）研究结果。
在北达科他州远程药学项目（NDTP）中，从中央订单录入站点为 17 家接受远程药学服务的 CAH 评估药物 QRE（即所有需要药剂师干预的药物治疗问题）的发生率和类型。在 17 个月的研究期间，远程药剂师使用远程药学技术审查 CAH 站点准备的药物订单，识别和解决 QRE，并对临床干预进行编码。收集的数据通过卡方检验进行分析。
CAH 研究站点的累积每月药物订单数量从研究的第一个月的 12,535 低到 18,257 高。每月的视觉药物验证和临床干预率分别为 8.0%至 14.2%和 1.3%至 3.1%。总体而言，最常识别的 QRE 是转录错误，占 2,389 次干预（43.3%）；2,078 次干预（37.7%）针对与处方相关的 QRE。引用最多的干预代码是剂量调整（n = 547）、深静脉血栓形成预防（n = 437）、药代动力学咨询（n = 268）、肾脏剂量（n = 182）和预防轻微（n = 148）和主要（n = 94）不良药物事件。
研究结果表明，NDTP 远程药学模型可有效识别和解决 CAH 中的 QRE。在研究期间，远程药学服务的使用量增加，表明 CAH 从业者越来越舒适地定期使用该技术，以提高患者安全性。
