Urbieta Sanz Elena, Trujilano Ruiz Abel, García-Molina Sáez Celia, Galicia Puyol Sonia, Caballero Requejo Carmen, Piñera Salmerón Pascual
Servicio de Farmacia. Hospital General Universitario Reina Sofía de Murcia..
Servicio de Urgencias. Hospital General Universitario Reina Sofía de Murcia. España..
Farm Hosp. 2014 Sep 16;38(5):430-7. doi: 10.7399/fh.2014.38.5.7663.
To evaluate the results of the implementation of a therapeutic reconciliation procedure (TRP) at admission by the emergency department (ED).
Prospective observational study conducted in the ED of a Referral Hospital Area. We collected the results of the implementation of a TRP from September to December 2012. A pharmacist attended daily to emergency department meeting and reviewed medical history to select those patients with high risk of reconciliation error (RE) according TRP. Afterwards, home medication history was elaborated with emergency department and primary care records and interview with the patient or caregiver. Therapeutic reconciliation took place with the emergency physician, considering RE any discrepancies not justified by the doctor. The potential severity of RE was assessed by emergency physicians outside the study using NCCMERP'S categorization.
The pharmacist collected an avarage of 1,3±2,2 home medication more than the emergency physician finding 564 discrepancies with the emergency record in 95,8% of the patients. 167 were RE affecting 69 patients (71,9%). Most of the errors were due to omissions of the drugs. Acceptance by emergency physicians of the reconciliation interventions was 73,9%. 58% of the RE were considered clinically relevants. Other interventions were also performed with an acceptance of 97%. Greater compliance with risk criteria, polypharmacy and pluripathology were associated with present RE and prescription of high-risk medications with the need for intervention.
The application of TRP avoided any error in most of the patients. TRP should extend to all patients at risk who admitted by the ED.
评估急诊科（ED）在入院时实施治疗性核对程序（TRP）的结果。
在一家转诊医院区域的急诊科进行前瞻性观察研究。我们收集了2012年9月至12月实施TRP的结果。一名药剂师每天参加急诊科会议并查阅病史，根据TRP选择那些存在核对错误（RE）高风险的患者。随后，结合急诊科和基层医疗记录以及对患者或护理人员的访谈，梳理家庭用药史。与急诊医生进行治疗性核对，将医生未说明理由的任何差异视为RE。研究外的急诊医生使用NCCMERP的分类方法评估RE的潜在严重程度。
药剂师平均比急诊医生多收集1.3±2.2种家庭用药，在95.8%的患者中发现与急诊记录有564处差异。167处为RE，影响69名患者（71.9%）。大多数错误是由于漏服药物。急诊医生对核对干预措施的接受率为73.9%。58%的RE被认为具有临床相关性。还进行了其他干预措施且接受率为97%。更高的风险标准依从性、多重用药和多种疾病与当前的RE以及需要干预的高风险药物处方相关。
TRP的应用在大多数患者中避免了任何错误。TRP应扩展到所有由ED收治的有风险的患者。
