Procopio Gabrielle L, Faley Brian, Wynd Michael A, Finefrock Douglas, Kobayashi Michelle, Feldman Joseph
Department of Pharmacy, Hackensack University Medical Center, Hackensack, NJ, USA; The Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.
Department of Emergency Medicine, Hackensack University Medical Center, Hackensack, NJ, USA.
SAGE Open Med. 2015 Aug 12;3:2050312115598872. doi: 10.1177/2050312115598872. eCollection 2015.
Clear processes to facilitate medication reconciliation in a hospital setting are still undefined. The observation unit allows for a high patient turnover rate, where obtaining accurate medication histories is critical.
The objective of this study was to assess the ability of pharmacists and student pharmacists to identify discrepancies in medication histories obtained at triage in observation patients.
Pharmacists and student pharmacists obtained a medication history for each patient placed in observation status. Patients were excluded if they were unable to provide a medication history and family, caregiver, or community pharmacy was also unable to provide the history. A comparison was made between triage and pharmacy collected medication histories to identify discrepancies.
A total of 501 medications histories were collected, accounting for 3213 medication records. There were 1176 (37%) matched medication records and 1467 discrepancies identified, including 808 (55%) omissions, 296 (20.2%) wrong frequency, 278 (19%) wrong dose, 51 (3.5%) discontinued, and 34 (2.3%) wrong medication. There was an average of 2.9 discrepancies per patient profile. In all, 76 (15%) of the profiles were matched. The median time to obtain a medication history was 4 min (range: 1-48 min).
Pharmacy collected medication histories in an observation unit identify discrepancies that can be reconciled by the interdisciplinary team.
在医院环境中促进用药核对的明确流程仍未确定。观察病房患者周转率高，获取准确的用药史至关重要。
本研究的目的是评估药剂师和药学专业学生识别观察病房患者分诊时所获取用药史差异的能力。
药剂师和药学专业学生为每位处于观察状态的患者获取用药史。若患者无法提供用药史且家属、护理人员或社区药房也无法提供，则将其排除。对比分诊时和药房收集的用药史以识别差异。
共收集了501份用药史，涉及3213条用药记录。有1176条（37%）用药记录匹配，识别出1467处差异，包括808处（55%）遗漏、296处（20.2%）用药频率错误、278处（19%）剂量错误、51处（3.5%）已停用药物以及34处（2.3%）药物错误。每位患者资料平均有2.9处差异。总计76份（15%）资料匹配。获取用药史的中位时间为4分钟（范围：1 - 48分钟）。
药房收集的观察病房患者用药史可识别出跨学科团队能够核对的差异。
