Tong E Y, Roman C, Mitra B, Yip G, Gibbs H, Newnham H, Smit D P, Galbraith K, Dooley M J
Pharmacy Department, Alfred Hospital, Melbourne, Vic., Australia.
Emergency and Trauma Centre, Alfred Hospital, Melbourne, Vic., Australia.
J Clin Pharm Ther. 2016 Aug;41(4):414-8. doi: 10.1111/jcpt.12405. Epub 2016 Jun 2.
Patients admitted to general medical units and emergency short-stay units are often complex with multiple comorbidities, polypharmacy and at risk for drug-related problems associated with increased morbidity and mortality. The aim of this study was to evaluate the effectiveness of a partnered pharmacist charting model completed at the time of admission to prevent medication errors.
We conducted an unblinded cluster randomized controlled trial comparing partnered pharmacist charting to standard medical charting among patients admitted to general medical units and emergency short-stay units with complex medication regimens or polypharmacy. This trial was conducted at an adult major referral hospital in metropolitan Melbourne, Australia, with an annual emergency department attendance of approximately 60 000 patients. The evaluation included patients' medication charts written in the period of 16 March 2015 to 27 July 2015. Patients randomized to the intervention were managed using the partnered pharmacist charting model. The primary outcome variable was a medication error identified by an independent assessor within 24 h of admission, who was not part of the patient's admission process.
Of the 473 patients who received standard medical staff charting during the study period, 372 (78·7%) had at least one medication error identified compared to 15 patients (3·7%) on the partnered pharmacist charting arm (P < 0·001). The relative risk of an error with standard medical charting was 21·4 (95% CI: 13·0-35·0) with a number needed to treat (NNT) to prevent one error of 1·3 (95% CI: 1·3-1·4), and the relative risk of a high or extreme risk error with standard medical charting was 150·9 (95% CI: 21·2-1072·9) with a NNT to prevent one high or extreme error of 2·7 (95% CI 2·4-3·1).
Partnering between medical staff and pharmacists to jointly chart initial medications on admission significantly reduced inpatient medication errors (including errors of high and extreme risk) among general medical and emergency short-stay patients with complex medication regimens or polypharmacy.
入住普通内科病房和急诊短期留观病房的患者情况通常较为复杂，存在多种合并症、同时服用多种药物，且有发生与发病率和死亡率增加相关的药物相关问题的风险。本研究的目的是评估入院时采用药师协同记录模式预防用药错误的有效性。
我们进行了一项非盲群集随机对照试验，在入住普通内科病房和急诊短期留观病房、用药方案复杂或同时服用多种药物的患者中，比较药师协同记录与标准医疗记录。该试验在澳大利亚墨尔本市区的一家大型成人转诊医院进行，急诊科每年接诊约60000名患者。评估纳入了2015年3月16日至2015年7月27日期间书写的患者用药记录。随机分配至干预组的患者采用药师协同记录模式进行管理。主要结局变量是由一名独立评估人员在入院后24小时内识别出的用药错误，该评估人员未参与患者的入院流程。
在研究期间接受标准医护人员记录的473例患者中，有372例（78.7%）被识别出至少有一处用药错误，而在药师协同记录组中这一比例为15例（3.7%）（P<0.001）。标准医疗记录出现错误的相对风险为21.4（95%CI：13.0 - 35.0），预防一处错误所需治疗人数（NNT）为1.3（95%CI：1.3 - 1.4）；标准医疗记录出现高风险或极高风险错误的相对风险为150.9（95%CI：21.2 - 1072.9），预防一处高风险或极高风险错误的NNT为2.7（95%CI：2.4 - 3.1）。
医护人员与药师合作，在入院时共同记录初始用药情况，可显著减少普通内科和急诊短期留观且用药方案复杂或同时服用多种药物的患者的住院用药错误（包括高风险和极高风险错误）。
