药剂师主导的方案对某大学医院改善药物过敏记录的影响。
Impact of a pharmacist-driven protocol to improve drug allergy documentation at a university hospital.
作者信息
Burrell Christopher, Tsourounis Candy, Quan David, Jue Vicki, Tam Eunice, Guglielmo B Joseph
机构信息
Clinical Fellow.
Professor of Clinical Pharmacy.
出版信息
Hosp Pharm. 2013 Apr;48(4):302-7. doi: 10.1310/hpj4804-302.
BACKGROUND
An internal evaluation of the inpatient pharmacy order entry database (WORx) at a university hospital revealed that the nature of the reaction was documented for only 47% of patients with reported drug allergies/intolerance. Insufficient documentation of drug allergy/intolerance may result in administration of drugs that should not be prescribed. Similarly, valuable agents that should be used may not be prescribed due to an unnecessary fear of adverse drug reaction. More complete description of drug allergy/intolerance may result in more correct prescribing of medications.
OBJECTIVE
Evaluate the impact of a pharmacist-driven protocol on the quality of drug allergy/intolerance documentation.
METHODS
Four pre-intervention evaluations were conducted every 2 weeks documenting the completeness of drug allergy/intolerance information in the pharmacy order entry database. One week following the implementation of a pharmacist-driven protocol intended to improve the completeness of drug allergy/intolerance information, a series of 4 postintervention evaluations was repeated. Proportional analysis of pre- and postinterventional data was performed to evaluate the effectiveness of the intervention.
RESULTS
A total of 1,686 allergies from 2,174 patients were reviewed pre and post intervention. The frequency of complete drug allergy/intolerance documentation pre intervention was 52% to 62%. Following implementation of the hospitalwide, pharmacist-driven protocol, this rate increased to 60% to 76%. Pediatric services demonstrated the most substantial improvement, increasing from 53% to 79% to 67% to 93%. Blank reaction fields decreased by 10% in both age groups.
CONCLUSION
A pharmacy-driven initiative intended to improve the completeness of drug allergy/intolerance documentation was associated with modest success. Other mechanisms, including electronic health record systems with computerized physician order entry and decision support, are needed to improve the completeness of drug allergy/intolerance information.
背景
对一家大学医院住院药房医嘱录入数据库（WORx）的内部评估显示，在报告有药物过敏/不耐受的患者中，只有47%记录了反应的性质。药物过敏/不耐受的记录不充分可能导致开具不应处方的药物。同样，由于不必要地担心药物不良反应，本应使用的有价值药物可能未被处方。对药物过敏/不耐受进行更完整的描述可能会使药物处方更正确。
目的
评估药剂师主导的方案对药物过敏/不耐受记录质量的影响。
方法
每2周进行4次干预前评估，记录药房医嘱录入数据库中药物过敏/不耐受信息的完整性。在实施旨在提高药物过敏/不耐受信息完整性的药剂师主导方案1周后，重复进行一系列4次干预后评估。对干预前后的数据进行比例分析，以评估干预的有效性。
结果
干预前后共审查了来自2174名患者的1686例过敏情况。干预前药物过敏/不耐受完整记录的频率为52%至62%。在全院实施药剂师主导的方案后，这一比例提高到60%至76%。儿科服务改善最为显著，从53%至79%提高到67%至93%。两个年龄组的空白反应字段均减少了10%。
结论
一项旨在提高药物过敏/不耐受记录完整性的药房驱动举措取得了一定成功。需要其他机制，包括具有计算机化医生医嘱录入和决策支持功能的电子健康记录系统，来提高药物过敏/不耐受信息的完整性。
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