Naas General Hospital, Kildare, Ireland.
School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin 2, Ireland.
Int J Clin Pharm. 2017 Feb;39(1):148-155. doi: 10.1007/s11096-016-0412-4. Epub 2016 Dec 22.
Background Medication reconciliation at admission to hospital reduces the prevalence of medication errors. Strategies are needed to ensure timely and efficient delivery of this service. Objective To investigate the effect of aligning clinical pharmacy services with consultant teams, by pharmacists attending post-admission ward rounds, in comparison to a ward-based service, on prevalence of unintentional unresolved discrepancies 48 h into admission. Setting A 243-bed public university teaching hospital in Ireland. Method A prospective, uncontrolled before-after observational study. A gold standard preadmission medication list was completed for each patient and compared with the patient's admission medication prescription and discrepancies were noted. Unresolved discrepancies were examined at 48 h after admission to determine if they were intentional or unintentional. Main outcome measured Number of patients with one or more unintentional, unresolved discrepancy 48 h into admission. Results Data were collected for 140 patients, of whom 73.5% were over 65 years of age. There were no differences between before (ward-aligned) and after (team-aligned) groups regarding age, number of medications or comorbidities. There was a statistically significant reduction in the prevalence of unintentional, unresolved discrepancy(s) per patient (67.3 vs. 27.3%, p < 0.001) and per medication (13.7 vs. 4.1%, p < 0.001) between the groups, favouring the team-based service. The effect remained statistically significant having adjusted for patient age, number of medications and comorbidities (adjusted odds ratio 4.9, 95% confidence interval 2.3-10.6). Conclusion A consultant team-based clinical pharmacy service contributed positively to medication reconciliation at admission, reducing the prevalence of unintentional, unresolved discrepancy(s) present 48 h after admission.
背景 入院时进行药物重整可降低药物错误的发生率。需要采取策略来确保及时有效地提供这项服务。 目的 本研究旨在通过药剂师参加入院后病房查房，将临床药学服务与顾问团队相协调，与基于病房的服务相比，调查其对入院后 48 小时内无意未解决差异的发生率的影响。 背景 这是一项在爱尔兰的 243 床位的公立大学教学医院进行的前瞻性、无对照的前后观察研究。为每位患者完成了一份黄金标准的入院前药物清单，并与患者的入院药物处方进行了比较，并记录了差异。在入院后 48 小时检查未解决的差异，以确定它们是有意还是无意的。 主要结局指标 入院后 48 小时内有一个或多个无意、未解决差异的患者人数。 结果 共收集了 140 名患者的数据，其中 73.5%的患者年龄超过 65 岁。在年龄、用药数量或合并症方面，前后组之间没有差异。与基于病房的服务相比，患者和药物的无意、未解决差异的发生率均显著降低（患者为 67.3%比 27.3%，p<0.001；药物为 13.7%比 4.1%，p<0.001）。在校正患者年龄、用药数量和合并症后，该差异仍具有统计学意义（调整后的优势比 4.9，95%置信区间 2.3-10.6）。 结论 顾问团队的临床药学服务为入院时的药物重整做出了积极贡献，降低了入院后 48 小时内无意未解决差异的发生率。
