Doolub Reshmee
United Kingdom.
BMJ Qual Improv Rep. 2017 Jun 8;6(1):e000064. doi: 10.1136/bmjquality-2017-000064. eCollection 2017.
Medicines reconciliation is integral to patient safety, symptom control and reducing patient anxiety. During a 3-month period on the respiratory ward at St. Peter's Hospital, 54% of drug charts were not reconciled with pre-admission medicines at the point of discharge for admissions up to 17 days. Only 18% were reconciled within 24 hours of admission. 50% of drug charts were missing 0-2 pre-admission medicines and 50% were missing 3-5 pre-admission medicines. The most common medicines that were not reconciled included topical applications which included eye, ear, nasal and skin applications (14%); vitamins i.e. vitamin B12 and thiamine, analgesia, PRN inhalers (11% individually); antidepressants and lipid regulators (6% individually); amongst a range of other medications including antiplatelets, calcium channel blockers, ACE inhibitors and diuretics. Two interventions were carried out to improve the rate of medicines reconciliation onto hospital drug charts with pre-admission medicines. These were: 1) a green sticker placed in the medical notes by the pharmacist when drug charts were incomplete, which required a date and signature from the doctor when the drug chart had been reconciled 2) the placing of the loose medicines reconciliation record (a list of pre-admission medicines retrieved from a reliable source usually by the pharmacist) to the front of the drug chart. These measures were designed to alert the doctors that the drug chart was incomplete. After 2 PDSA cycles, the results showed positive outcomes. In 75% of the cases where the interventions were used, medicines reconciliation was complete at the point of discharge with 34% of drug charts reconciled within 24 hours of admission. Of the 25% of drug charts that were not reconciled despite the use of the interventions, 100% of them were missing 0-2 medicines however 0% were missing 3-5 medicines. This highlights that the interventions were effective in improving the rates of medicines reconciliation.
药物重整对于患者安全、症状控制及减轻患者焦虑至关重要。在圣彼得医院呼吸科病房为期3个月的时间里，对于住院时长可达17天的患者，54%的药物记录在出院时未与入院前用药进行核对。入院后24小时内仅18%的药物记录得到核对。50%的药物记录缺失0 - 2种入院前用药，50%的药物记录缺失3 - 5种入院前用药。最常未被核对的药物包括局部用药，如眼部、耳部、鼻部及皮肤用药（14%）；维生素，即维生素B12和硫胺素、镇痛药、按需使用的吸入器（各占11%）；抗抑郁药和血脂调节剂（各占6%）；以及一系列其他药物，包括抗血小板药、钙通道阻滞剂、血管紧张素转换酶抑制剂和利尿剂。开展了两项干预措施以提高医院药物记录与入院前用药的核对率。措施如下：1）当药物记录不完整时，药剂师在病历中放置一张绿色标签，药物记录核对完成后需医生注明日期并签字；2）将松散的药物重整记录（通常由药剂师从可靠来源获取的入院前用药清单）放在药物记录的首页。这些措施旨在提醒医生药物记录不完整。经过2个计划 - 执行 - 检查 - 处理（PDSA）循环，结果显示取得了积极成效。在75%采用干预措施的病例中，出院时药物重整完成，34%的药物记录在入院后24小时内得到核对。在25%尽管采用了干预措施仍未完成核对的药物记录中，100%缺失0 - 2种药物，然而缺失3 - 5种药物的比例为0%。这表明这些干预措施在提高药物重整率方面是有效的。
