Sebaaly Jamie, Parsons Laura Beth, Pilch Nicole A Weimert, Bullington Wendy, Hayes Genevieve L, Easterling Heather
PGY1 Pharmacotherapy Practice Resident, Department of Pharmacy Services, Medical University of South Carolina (MUSC) , Charleston.
PGY 1 Pharmacy Practice Resident, Department of Pharmacy Services, MUSC , Charleston.
Hosp Pharm. 2015 Jun;50(6):505-13. doi: 10.1310/hpj5006-505.
Medication reconciliation is one of the more challenging aspects of inpatient care, and its accuracy is paramount to safe transitions of care. Studies have shown that pharmacists have a role in medication reconciliation through improving patient safety and avoiding costs associated with medication errors. The wide-scale use of pharmacists in this process has been limited by time constraints, cost, and lack of resources.
This study evaluates the impact of pharmacists in resolving medication errors, decreasing readmission rates, and reducing institutional costs during the discharge medication reconciliation process.
Pharmacists evaluated discharge medication reconciliation documentation for patients to determine its accuracy, the accuracy of the admission reconciliation documentation, and any potential issues unrelated to accuracy. Analysis of these data determined the time required for pharmacist involvement, the number of errors identified by pharmacists, the quality of pharmacist interventions, the cost avoidance for each error, and the overall impact on hospital readmission.
During the 7-week study period, pharmacists performed 67 discharge medication reviews and identified 84 errors. Seventy-five percent were considered to be significant and 6% were considered to be serious. The 30-day readmission rate in the study cohort was 18% compared with 20% in the control group. Based on the clinical severity scale and pharmacist salaries, pharmacist interventions resulted in $42,300 in cost avoidance.
Pharmacists involved in this pilot discharge process identified and resolved significant errors on medication reconciliation orders that resulted in a financial benefit to the institution.
用药核对是住院治疗中较具挑战性的环节之一，其准确性对于安全的护理转接至关重要。研究表明，药剂师在用药核对中发挥着作用，可提高患者安全性并避免与用药错误相关的成本。在此过程中广泛使用药剂师受到时间限制、成本和资源匮乏的制约。
本研究评估药剂师在出院用药核对过程中解决用药错误、降低再入院率和减少机构成本方面的影响。
药剂师评估患者的出院用药核对文件，以确定其准确性、入院核对文件的准确性以及任何与准确性无关的潜在问题。对这些数据的分析确定了药剂师参与所需的时间、药剂师识别的错误数量、药剂师干预的质量、每个错误避免的成本以及对医院再入院的总体影响。
在为期7周的研究期间，药剂师进行了67次出院用药审查，识别出84个错误。其中75%被认为是重大错误，6%被认为是严重错误。研究队列中的30天再入院率为18%，而对照组为20%。根据临床严重程度量表和药剂师薪资，药剂师的干预避免了42,300美元的成本。
参与此次试点出院流程的药剂师识别并解决了用药核对医嘱中的重大错误，为机构带来了经济收益。
