转诊至社区护理服务机构的老年人的药物管理、用药错误及药物不良事件：一项回顾性观察研究
Medicines Management, Medication Errors and Adverse Medication Events in Older People Referred to a Community Nursing Service: A Retrospective Observational Study.
作者信息
Elliott Rohan A, Lee Cik Yin, Beanland Christine, Vakil Krishna, Goeman Dianne
机构信息
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC, 3052, Australia.
Pharmacy Department, Austin Health, P.O. Box 5444, Heidelberg West, VIC, 3081, Australia.
出版信息
Drugs Real World Outcomes. 2016 Mar;3(1):13-24. doi: 10.1007/s40801-016-0065-6.
BACKGROUND
Increasing numbers of older people are receiving support with medicines management from community nursing services (CNSs) to enable them to live in their own homes. Little is known about these people and the support they receive.
OBJECTIVES
To explore the characteristics of older people referred for medicines management support, type of support provided, medication errors and adverse medication events (AMEs).
METHODS
A retrospective observational study of a random sample of 100 older people referred to a large non-profit CNS for medicines management support over a 3-month period was conducted. Measures were: demographics, referral source, current medical problems, medicines, medication aids, types of medication authorisations used by nurses, frequency of nurse visits and type of support provided, medication errors, AMEs and interdisciplinary teamwork among community nurses, general practitioners and pharmacists.
RESULTS
Older people (median 80 years) were referred for medicines support most often by hospitals (39 %). Other referrals were from families/carers, case-managers, palliative care services and general practitioners. Multiple health conditions (median 5) and medicines (median 10) were common; 66 % used ≥5 medicines; 48 % used ≥1 high-risk medicines-most commonly opiates, anticoagulants and insulin. Medication aids were frequently used, mostly multi-compartment dose administration aids (47 %). Most people received regular community nurse visits (≥4 per week) to administer medicines or monitor medicine-taking. Only 16 % had a medication administration chart; for other clients nurses used medicine lists or letters from doctors for medication authorisation. Medication errors occurred in 41 % of people and 13 % had ≥1 AME requiring medical consultation or hospitalisation; 9/13 (64 %) AMEs were potentially preventable. There was little evidence of interdisciplinary teamwork or medication review.
CONCLUSION
CNS clients had multiple risk-factors for medication misadventure. Deficiencies in medicines management were identified, including low use of medication charts and interdisciplinary medication review. Strategies are needed to improve medicines management in the home-care setting.
背景
越来越多的老年人正在接受社区护理服务（CNSs）提供的药物管理支持，以便能够居家生活。对于这些人以及他们所接受的支持了解甚少。
目的
探讨被转介接受药物管理支持的老年人的特征、所提供的支持类型、用药错误和药物不良事件（AMEs）。
方法
对在3个月期间被转介到一家大型非营利性CNS接受药物管理支持的100名老年人的随机样本进行回顾性观察研究。测量指标包括：人口统计学特征、转介来源、当前的医疗问题、药物、给药辅助工具、护士使用的药物授权类型、护士家访频率和所提供的支持类型、用药错误、AMEs以及社区护士、全科医生和药剂师之间的跨学科团队合作。
结果
老年人（中位年龄80岁）最常由医院转介接受药物支持（39%）。其他转介来自家庭/护理人员、个案管理员、姑息治疗服务机构和全科医生。多种健康状况（中位值为5种）和药物（中位值为10种）很常见；66%的人使用≥5种药物；48%的人使用≥1种高风险药物——最常见的是阿片类药物、抗凝剂和胰岛素。经常使用给药辅助工具，大多是多格剂量给药辅助工具（47%）。大多数人接受社区护士定期家访（每周≥4次）以给药或监测服药情况。只有16%的人有给药记录单；对于其他客户，护士使用药物清单或医生的信件进行药物授权。41%的人发生用药错误，13%的人发生≥1次需要医疗咨询或住院治疗的AMEs；13例AMEs中有9例（64%）可能是可预防的。几乎没有跨学科团队合作或药物审查的证据。
结论
CNS的客户存在多种用药差错风险因素。已确定药物管理存在缺陷，包括给药记录单使用率低和跨学科药物审查不足。需要采取策略来改善居家护理环境中的药物管理。
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