Hart Coleen, Price Christine, Graziose Glenn, Grey Jonathan
P T. 2015 Jan;40(1):56-61.
To evaluate the percentage, frequency, and types of medication history errors made by pharmacy technicians compared with nurses in the emergency department (ED) to determine if patient safety and care can be improved while reducing nurses' workloads.
Medication history errors were evaluated in a pre-post study comparing a historical control group (nurses) prior to the implementation of a pharmacy technician program in the ED to a prospective cohort group (pharmacy technicians). Two certified pharmacy technicians were trained by the post-graduate year one (PGY1) pharmacy practice resident to conduct medication history interviews in a systematic fashion, with outside resources (i.e., assisted living facility, pharmacy, physician's office, or family members) being consulted if any portion of the medication history was unclear or lacking information. The primary outcome compared the percentage of patients with accurate medication histories in each group. Secondary outcomes included differences between groups regarding total medication errors, types of errors, documentation of patient allergies and drug reactions, and documentation of last administration times for high-risk anticoagulant/antiplatelet medications. Accuracy was determined by reviewing each documented medication history for identifiable errors, including review of electronic generated prescriptions within the hospital system as well as physician notes or histories documented on the same day (for potential discrepancies). This review was performed by the pharmacy resident. The categories of errors included a drug omission, a drug commission, an incorrect or missing drug, an incorrect or missing dose, or an incorrect or missing frequency. Anonymous surveys were distributed to ED nurses to assess their feedback on the new medication reconciliation program using pharmacy technicians.
A total of 300 medication histories from the ED were evaluated (150 in each group). Medication histories conducted by pharmacy technicians were accurate 88% of the time compared with 57% of those conducted by nurses (P < 0.0001). Nineteen errors (1.1%) were made by pharmacy technicians versus 117 (8.3%) by nurses (relative risk [RR], 7.5; P < 0.0001). The most common type of error was an incorrect or missing dose (10 versus 59, P < 0.001), followed by an incorrect or missing frequency (0 versus 30, P < 0.0001), and a drug commission (5 versus 23, P = 0.004). There were no differences between groups regarding the documentation of patient allergies. Documentation rates of high-risk anticoagulant and antiplatelet administration times were greater for pharmacy technicians than for nurses (76% versus 13%, P < 0.001).
This study demonstrates that trained pharmacy technicians can assist prescribers and nurses by improving the accuracy of medication histories obtained in the ED.
评估急诊科药房技术员与护士相比所犯用药史错误的百分比、频率和类型，以确定在减轻护士工作量的同时能否提高患者安全和护理质量。
在一项前后对照研究中评估用药史错误，将急诊科实施药房技术员项目之前的历史对照组（护士）与前瞻性队列组（药房技术员）进行比较。两名经过认证的药房技术员由第一年住院医师培训的药房实习生培训，以系统的方式进行用药史访谈，如果用药史的任何部分不清楚或缺乏信息，则咨询外部资源（即辅助生活设施、药房、医生办公室或家庭成员）。主要结果比较了每组中用药史准确的患者百分比。次要结果包括两组在总用药错误、错误类型、患者过敏和药物反应的记录以及高风险抗凝/抗血小板药物最后给药时间的记录方面的差异。通过审查每份记录的用药史以确定可识别的错误来确定准确性，包括审查医院系统内电子生成的处方以及同一天记录的医生笔记或病史（以查找潜在差异）。这项审查由药房实习生进行。错误类别包括药物遗漏、药物误开、药物错误或遗漏、剂量错误或遗漏，或频率错误或遗漏。向急诊科护士分发了匿名调查问卷，以评估他们对使用药房技术员的新用药核对计划的反馈。
共评估了来自急诊科的300份用药史（每组150份）。药房技术员进行的用药史88%的时间是准确的，而护士进行的用药史这一比例为57%（P < 0.0001）。药房技术员犯了19个错误（1.1%），而护士犯了117个错误（8.3%）（相对风险[RR]，7.5；P < 0.0001）。最常见的错误类型是剂量错误或遗漏（10个对59个，P < 0.001），其次是频率错误或遗漏（0个对30个，P < 0.0001），以及药物误开（5个对23个，P = 0.004）。两组在患者过敏记录方面没有差异。药房技术员对高风险抗凝和抗血小板药物给药时间的记录率高于护士（76%对'13%，P < 0.001）。
本研究表明，经过培训的药房技术员可以通过提高在急诊科获得的用药史的准确性来协助开处方者和护士。
