Sardaneh Arwa A, Burke Rosemary, Ritchie Angus, McLachlan Andrew J, Lehnbom Elin C
Faculty of Pharmacy, University of Sydney, Sydney, Australia.
Pharmacy Department, Concord Repatriation General Hospital, Concord, Australia; Clinical Lead, Electronic Medication Management, Concord Repatriation General Hospital, Concord, Australia.
Int J Med Inform. 2017 May;101:41-49. doi: 10.1016/j.ijmedinf.2017.02.001. Epub 2017 Feb 8.
To investigate the impact of the introduction of an electronic medication management system on the proportion of patients with a recorded medication reconciliation on admission, the time from admission to when medication reconciliation was performed, and the characteristics of patients receiving this intervention pre-and post-implementation.
An electronic medication management system was implemented in an Australian hospital from May to July 2015. A retrospective observational study was conducted in three wards across two phases; pre- (August 2014) and post- (August 2015) implementation. The study sample included every second patient admitted to these wards.
A total of 370 patients were included, 179 pre- and 191 post-implementation. The proportion of recorded admission medication reconciliation significantly increased post-implementation in all study wards; coronary care unit (40 vs 68%, p=0.004), gastroenterology ward (39 vs 59%, p=0.015), and the neurology ward (19 vs 45%, p=0.002). The proportion of patients with recorded medication reconciliation within 24h of weekday admissions, or 48-72h of weekend admissions, increased from 47% pre- to 84% post-implementation. Admission medication reconciliation was recorded within a median of 1.0day for weekday admissions pre- and post-implementation (IQR 1.1 vs 0.2, respectively), and 3.5days (IQR 2.0) pre-implementation vs 1.5days (IQR 2.0) post-implementation for weekend admissions. Overall, across both phases pre-and post-implementation, admission medication reconciliation was recorded for patients who were significantly older (median 77 and 71 years, p<0.001), had a higher number of preadmission medications (median 6.5 and 5.0 medicines, p=0.001), and had a longer hospital stay (median 6.5 and 5.1days, p=0.003). A significantly higher proportion of patients with recorded medication reconciliation in the pre-implementation phase experienced polypharmacy (61%, p=0.002), hyperpolypharmacy (15%, p=0.001), and used a high-risk medication (44%, p=0.007).
Implementing an electronic medication management system facilitates the medication reconciliation process leading to more high risk patients receiving this service on admission to hospital and in a more timely manner. The impact of electronic medication reconciliation on patient safety and clinical outcomes remains unknown.
探讨引入电子药物管理系统对入院时进行药物重整记录的患者比例、从入院到进行药物重整的时间，以及实施干预前后接受该干预的患者特征的影响。
2015年5月至7月，澳大利亚一家医院实施了电子药物管理系统。在两个阶段对三个病房进行了回顾性观察研究；实施前（2014年8月）和实施后（2015年8月）。研究样本包括这些病房每第二位入院的患者。
共纳入370例患者，实施前179例，实施后191例。在所有研究病房中，实施后记录的入院药物重整比例显著增加；冠心病监护病房（40%对68%，p = 0.004）、胃肠病病房（39%对59%，p = 0.015）和神经科病房（19%对45%，p = 0.002）。工作日入院24小时内或周末入院48 - 72小时内有药物重整记录的患者比例从实施前的47%增加到实施后的84%。实施前后，工作日入院的药物重整记录中位数均为1.0天（四分位间距分别为1.1天和0.2天），周末入院实施前为3.5天（四分位间距2.0天），实施后为1.5天（四分位间距2.0天）。总体而言，在实施前后两个阶段，有药物重整记录的患者年龄显著更大（中位数分别为77岁和71岁，p < 0.001），入院前用药数量更多（中位数分别为6.5种和5.0种药物，p = 0.001），住院时间更长（中位数分别为6.5天和5.1天，p = 0.003）。实施前阶段有药物重整记录的患者中，多重用药（6l%，p = 0.002）、超多重用药（15%，p = 0.001）和使用高风险药物（44%，p = 0.007）的比例显著更高。
实施电子药物管理系统有助于药物重整过程，使更多高危患者入院时能更及时地接受这项服务。电子药物重整对患者安全和临床结局的影响尚不清楚。
