Keers R N, Williams S D, Vattakatuchery J J, Brown P, Miller J, Prescott L, Ashcroft D M
Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK.
NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, MAHSC, University of Manchester, Manchester, UK.
J Clin Pharm Ther. 2015 Dec;40(6):645-54. doi: 10.1111/jcpt.12328. Epub 2015 Nov 3.
When compared to general hospitals, relatively little is known about the quality and safety of discharge prescriptions from specialist mental health settings. We aimed to investigate the quality and safety of discharge prescriptions written at mental health hospitals.
This study was undertaken on acute adult and later life inpatient units at three National Health Service (NHS) mental health trusts. Trained pharmacy teams prospectively reviewed all newly written discharge prescriptions over a 6-week period, recording the number of prescribing errors, clerical errors and errors involving lack of communication about medicines stopped during hospital admission. All prescribing errors were reviewed and validated by a multidisciplinary panel. Main outcome measures were the prevalence (95% CI) of prescribing errors, clerical errors and errors involving a lack of details about medicines stopped. Risk factors for prescribing and clerical errors were examined via logistic regression and results presented as odds ratios (OR) with corresponding 95% CI.
Of 274 discharge prescriptions, 259 contained a total of 1456 individually prescribed items. One in five [20·8% (95%CI 15·9-25·8%)] eligible discharge prescriptions and one in twenty [5·1% (95%CI 4·0-6·2%)] prescribed or omitted items were affected by at least one prescribing error. One or more clerical errors were found in 71·9% (95%CI 66·5-77·3%) of discharge prescriptions, and more than two-thirds [68·8% (95%CI 56·6-78·8%)] of eligible discharge prescriptions erroneously lacked information on medicines discontinued during hospital admission. Logistic regression analyses revealed that middle-grade [whole discharge prescription level OR 3·28 (3·03-3·56)] and senior [whole discharge OR 1·43 (1·04-1·96)] prescribers as well as electronic discharge prescription pro formas [whole discharge OR 2·43 (2·08-2·83)] were all associated with significantly higher risks of prescribing errors than junior prescribers and handwritten discharges, respectively. Similar findings were reported at the individually prescribed item level. Middle-grade prescribers were also more likely to make both non-psychotropic and psychotropic prescribing errors than their junior colleagues [individual item OR 4·24 (2·14-8·40) and OR 1·70 (1·16-2·48), respectively].
Discharge prescriptions issued by mental health NHS hospitals are affected by high levels of prescribing, clerical and communication errors. Important targets for intervention have been identified to improve medication safety problems at care transfer.
与综合医院相比，我们对专科心理健康机构出院处方的质量和安全性了解相对较少。我们旨在调查精神科医院开具的出院处方的质量和安全性。
本研究在三个国民保健服务（NHS）精神健康信托基金的急性成人和老年住院病房进行。经过培训的药学团队对6周内所有新开具的出院处方进行前瞻性审查，记录处方错误、文书错误以及涉及住院期间停用药物但缺乏沟通的错误数量。所有处方错误均由多学科小组进行审查和验证。主要结局指标为处方错误、文书错误以及涉及停用药物信息缺失的错误的发生率（95%置信区间）。通过逻辑回归分析处方错误和文书错误的风险因素，并将结果表示为比值比（OR）及相应的95%置信区间。
在274份出院处方中，259份共包含1456个单独开具的药品项目。五分之一[20.8%（95%置信区间15.9 - 25.8%）]的合格出院处方以及二十分之一[5.1%（95%置信区间4.0 - 6.2%）]的开具或遗漏项目受到至少一处处方错误的影响。在71.9%（95%置信区间66.5 - 77.3%）的出院处方中发现了一处或多处文书错误，超过三分之二[68.8%（95%置信区间56.6 - 78.8%）]的合格出院处方错误地缺少住院期间停用药物的信息。逻辑回归分析显示，中级[整个出院处方水平的OR为3.28（3.03 - 3.56）]和高级[整个出院处方的OR为1.43（1.04 - 1.96）]开方者以及电子出院处方模板[整个出院处方的OR为2.43（2.08 - 2.83）]分别比初级开方者和手写出院处方与更高的处方错误风险显著相关。在单独开具的药品项目层面也报告了类似的结果。中级开方者比初级同事更有可能出现非精神药物和精神药物的处方错误[单个项目的OR分别为4.24（2.14 - 8.40）和1.70（1.16 - 2.48）]。
NHS精神科医院开具的出院处方受到高水平的处方、文书和沟通错误的影响。已确定了重要的干预目标，以改善护理转接时的用药安全问题。
