Heselmans A, van Krieken J, Cootjans S, Nagels K, Filliers D, Dillen K, De Broe S, Ramaekers D
School of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Belgium.
AZ Sint Maarten General Hospital, Hospital Pharmacy, Mechelen, Belgium.
J Clin Pharm Ther. 2015 Oct;40(5):578-583. doi: 10.1111/jcpt.12314. Epub 2015 Aug 12.
Drug-related problems (DRPs) occur frequently in hospitalized patients. Patient discharge from the intensive care unit (ICU) to a non-ICU ward is one of the most challenging and high-risk transitions of care due to the number of medications, and the complexity and acuity of the medical conditions that characterize this patient group. Pharmacists could play an important role in preventing DRPs. This study was undertaken to evaluate the impact on the number and severity of drug-related problems by assigning a clinical pharmacist to the transfer process from ICU to wards.
The study was a randomized controlled multicentre trial conducted at the Hospital Network of Antwerp between December 2010 and January 2012. The clinical pharmacist performed a medical review in both the intervention and control group. Recommendations for drug therapy changes were immediately communicated in the intervention group but were kept blinded in the control group. The primary outcome was expressed as the number of implemented recommendations for drug therapy changes. Differences between groups were calculated using mixed effects binary logistic regression.
Drug-related problems were found in the medical records of 360 of the 600 participants (60%). A total of 743 recommendations could be made, 375 in the intervention group and 368 in the control group. 54·1% of these problems were adjusted on time in the intervention group vs. 12·8% in the control group. Of 743 recommendations, 24·8% were judged by the expert group as major, 13·1% as moderate, 53.4% as minor and 8·9% as having no clinical impact. The odds of implementing recommendations of drug therapy changes in the intervention group were 10 times the odds of implementing recommendations of drug therapy changes in the control group (odds ratio = 10·1; 95%CI [6·3-16·1]; P < 0·001), even after accounting for differences in types of DRP between the groups (odds ratio = 15·6; 95%CI [9·4-25·9]; P < 0·001).
The integration of a clinical pharmacist at the transfer point from ICU to ward led to a significant reduction in DRPs.
住院患者中药物相关问题（DRP）频繁发生。由于用药数量以及该患者群体所具有的医疗状况的复杂性和严重性，患者从重症监护病房（ICU）转至非ICU病房是最具挑战性且风险最高的护理过渡之一。药剂师在预防DRP方面可发挥重要作用。本研究旨在通过为从ICU到病房的转运过程安排一名临床药剂师，评估其对药物相关问题的数量和严重程度的影响。
该研究是一项于2010年12月至2012年1月在安特卫普医院网络进行的随机对照多中心试验。临床药剂师在干预组和对照组均进行了医学评估。干预组中关于药物治疗变更的建议立即进行了沟通，但对照组对此保持盲态。主要结局以实施的药物治疗变更建议数量表示。使用混合效应二元逻辑回归计算组间差异。
600名参与者中有360名（60%）的病历中发现了药物相关问题。总共可提出743条建议，干预组375条，对照组368条。干预组中这些问题有54.1%得到及时调整，而对照组为12.8%。在743条建议中，专家组判定24.8%为主要问题，13.1%为中度问题，53.4%为轻度问题，8.9%无临床影响。即使考虑到组间DRP类型的差异，干预组实施药物治疗变更建议的几率仍是对照组的10倍（优势比 = 10.1；95%置信区间[6.3 - 16.1]；P < 0.001）（优势比 = 15.6；95%置信区间[9.4 - 25.9]；P < 0.001）。
在从ICU到病房的转运点整合临床药剂师可显著减少药物相关问题。
