MacDonald Nicole, Manuel Leslie, Brennan Haley, Musgrave Erin, Wanbon Richard, Stoica George
, BSc(Pharm), ACPR, is with the Health Sciences Centre, Eastern Health, St John's, Newfoundland and Labrador.
, BSc(Chem), BSc(Pharm), PharmD, ACPR, is with Horizon Health Network - The Moncton Hospital, Moncton, New Brunswick.
Can J Hosp Pharm. 2017 Jul-Aug;70(4):263-269. doi: 10.4212/cjhp.v70i4.1675. Epub 2017 Aug 31.
Accreditation standards have outlined the need for staff in emergency departments to initiate the medication reconciliation process for patients who are at risk of adverse drug events. The authors hypothesized that a guided form could be used by non-admitted patients in the emergency department to assist with completion of a best possible medication history (BPMH).
To determine the percentage of patients in the non-acute care area of the emergency department who could complete a guided BPMH form with no clinically significant discrepancies (defined as no major discrepancies and no more than 1 moderate discrepancy).
This prospective exploratory study was conducted over 4 weeks in February and March 2016. Data were collected using the self-administered BPMH form, patient interviews, and a data collection form. After completion of the guided BPMH form, patients were randomly selected for interview by a pharmacy team member to ensure their self-completed BPMH forms were complete and accurate. Eligible patients were those with non-acute needs who had undergone triage to the waiting room. Patients who were already admitted and those with immediate triage to the acute care or trauma area of the emergency department were excluded.
Of the 160 patients who were interviewed, 146 (91.3%) completed the form with no more than 1 moderate discrepancy (but some number of minor discrepancies). There were no discrepancies in 31 (19.4%) of the BPMH forms, and 101 (63.1%) of the forms had only minor discrepancies.
Most of the patients interviewed by the pharmacy team were able to complete the BPMH form with no clinically significant discrepancies. The self-administered BPMH form would be a useful tool to initiate medication reconciliation in the emergency department for this patient population, but used on its own, it would not be a reliable source of BPMH information, given the relatively low number of patients who completed the form with no discrepancies.
认证标准已明确指出，急诊科工作人员有必要为存在药物不良事件风险的患者启动用药核对流程。作者推测，急诊科未住院患者可使用一份指导性表格来协助完成最佳用药史（BPMH）。
确定急诊科非急症护理区域中能够完成一份无临床显著差异（定义为无重大差异且不超过1处中度差异）的指导性BPMH表格的患者比例。
这项前瞻性探索性研究于2016年2月和3月进行，为期4周。使用自行填写的BPMH表格、患者访谈以及一份数据收集表来收集数据。在完成指导性BPMH表格后，由药房团队成员随机选择患者进行访谈，以确保他们自行填写的BPMH表格完整且准确。符合条件的患者是那些有非急症需求且已分诊至候诊室的患者。已住院的患者以及直接分诊至急诊科急症护理或创伤区域的患者被排除在外。
在接受访谈的160名患者中，146名（91.3%）完成的表格存在不超过1处中度差异（但有一些小差异）。31份（19.4%）BPMH表格无差异，101份（63.1%）表格仅有小差异。
药房团队访谈的大多数患者能够完成BPMH表格且无临床显著差异。自行填写的BPMH表格对于该患者群体在急诊科启动用药核对将是一个有用的工具，但鉴于完成表格无差异的患者数量相对较少，仅靠它本身并非BPMH信息的可靠来源。
