Marotti Sally B, Cheh Rachael May Theng, Ponniah Anne, Phuong Helen
SA Health, Woodville South, SA, Australia.
Int J Clin Pharm. 2017 Apr;39(2):403-407. doi: 10.1007/s11096-017-0438-2. Epub 2017 Mar 15.
Background Medication-related hospital admissions in Australia have previously been estimated to account for approximately 3% of all hospital admissions, with hospital entry points being a point of vulnerability. The timely medication review and reconciliation by a pharmacist at the early stage of an admission for patients admitted to the Acute Medical Unit (AMU) would be beneficial. Setting The Emergency Department (ED) and AMU in a 300 bed tertiary teaching hospital, in South Australia. Objective To investigate the impact of a Medical Admissions (MA) pharmacist on the proportion of AMU patients who receive a complete and accurate medication history by a pharmacist prior to admission and within 4 h of presentation. Method This prospective observational study with a non-concurrent parallel study design examined a standard clinical pharmacist service within the AMU and ED to a Medical Admissions (MA) Pharmacist, in addition to the standard AMU and ED pharmacist service. Continuous variables were analysed using a two sample t test, whilst categorical data were analysed using Fisher's exact test. Risk ratios were also calculated for categorical data, with p < 0.05 taken as statistically significant. Main outcome measures Rates of completion of a complete medication history prior to admission and proportion of patients seen within 4 h of presentation by a pharmacist. Results The intervention resulted in more patients receiving a complete medication history prior to admission (2.7% in the control group vs 18.5%, p < 0.01) and being seen by the pharmacist within 4 h of presentation (1.6% in the control group vs 7.5%, p < 0.01). Conclusion Implementation of an extended hours clinical pharmacy service in the form of a medical admissions pharmacist based in the ED significantly increased the number of complete medication histories and clinical reviews completed for patients being admitted to an AMU. These were also completed earlier in the patients' admission. There was also a small trend toward increasing the proportion of patients discharged by 11 am in the intervention group.
背景 此前估计，澳大利亚与用药相关的住院病例约占所有住院病例的3%，入院环节是一个脆弱点。对于入住急性内科病房（AMU）的患者，在入院早期由药剂师及时进行用药评估和核对会有所助益。地点 南澳大利亚州一家拥有300张床位的三级教学医院的急诊科（ED）和AMU。目的 调查内科入院（MA）药剂师对在入院前及就诊后4小时内由药剂师获取完整准确用药史的AMU患者比例的影响。方法 这项采用非同期平行研究设计的前瞻性观察性研究，除了标准的AMU和ED药剂师服务外，还考察了AMU和ED内针对MA药剂师的标准临床药剂师服务。连续变量采用两样本t检验进行分析，分类数据采用Fisher精确检验进行分析。还计算了分类数据的风险比，p<0.05被视为具有统计学意义。主要观察指标 入院前完成完整用药史的比例以及药剂师在就诊后4小时内接诊的患者比例。结果 干预措施使更多患者在入院前获得了完整用药史（对照组为2.7%，干预组为18.5%，p<0.01），并且在就诊后4小时内由药剂师接诊（对照组为1.6%，干预组为7.5%，p<0.01）。结论 以驻急诊科的内科入院药剂师形式实施延长工作时间的临床药学服务，显著增加了为入住AMU患者完成的完整用药史数量和临床评估数量。这些也在患者入院更早阶段完成。干预组还有一个小趋势，即上午11点前出院的患者比例有所增加。
