Cortejoso L, Dietz R A, Hofmann G, Gosch M, Sattler A
Department of Pharmacy.
Department of Geriatrics, Hospital Nuremberg, Paracelsus Medical Private University Nuremberg, Nuremberg, Germany.
Clin Interv Aging. 2016 Sep 26;11:1343-1350. doi: 10.2147/CIA.S109048. eCollection 2016.
Inappropriate pharmacotherapy among older adults remains a critical issue in our health care systems. Besides polypharmacy and multiple comorbidities, the age-related pharmacokinetic and pharmacodynamic changes may increase the risk of adverse drug reactions and medication errors.
The main target of this study was to describe the characteristics of pharmaceutical interventions in two geriatric wards (orthogeriatric ward and geriatric day unit) of a general teaching hospital and to evaluate the clinical significance of the detected medication errors.
The study was conducted between August 2014 and October 2015 and was based on a triple approach that included validation of medical orders, medication reconciliation at patients' admission, and a predischarge planning appointment with the patient. The validation of medical orders was based on analyzing the suitability of the drugs prescribed, the drug dose depending on the patient's characteristics, the presence of contraindications and interactions between drugs, and the proposal of alternative drugs included in the hospital formulary.
A total of 2,307 interventions associated to a medication error in 15,282 medical orders for 1,859 older patients were recorded. The greater part of the interventions carried out on the orthogeriatric ward at admission and at discharge were due to omission of a drug in the medical order (20.0%) and clinically significant interactions requiring monitoring (30.4%), respectively. The main factor triggering pharmacist's recommendations on the geriatric day unit was clinically significant interactions (21.1%). With regard to the clinical severity of the detected errors, 68.1% were considered significant, 24.8% were of minor significance, and 7.2% were clinically serious.
Our findings show the importance of clinical pharmacist involvement in the optimization of pharmacotherapy in older adults, ensuring that they receive effective, safe, and efficient drug therapy.
老年人不适当的药物治疗仍是我们医疗保健系统中的一个关键问题。除了多重用药和多种合并症外，与年龄相关的药代动力学和药效学变化可能会增加药物不良反应和用药错误的风险。
本研究的主要目标是描述一家综合教学医院两个老年病房（骨科老年病房和老年日间病房）的药学干预特征，并评估所发现用药错误的临床意义。
该研究于2014年8月至2015年10月进行，基于一种三重方法，包括医嘱验证、患者入院时的用药核对以及与患者的出院前规划预约。医嘱验证基于分析所开药物的适用性、根据患者特征确定的药物剂量、药物之间禁忌和相互作用的存在情况以及医院处方集所包含替代药物的建议。
在1859名老年患者的15282份医嘱中，共记录了2307项与用药错误相关的干预措施。在骨科老年病房入院和出院时进行的大部分干预分别是由于医嘱中遗漏药物（20.0%）和需要监测的具有临床意义的相互作用（30.4%）。在老年日间病房引发药师建议的主要因素是具有临床意义的相互作用（21.1%）。关于所发现错误的临床严重程度，68.1%被认为具有显著性，24.8%具有较小显著性，7.2%具有临床严重性。
我们的研究结果表明临床药师参与优化老年人药物治疗的重要性，确保他们接受有效、安全和高效的药物治疗。
