Bourne Richard S, Shulman Rob, Jennings Jennifer K
Departments of Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK.
Pharmacy Department, University College Hospital NHS Foundation Trust, London, UK.
Int J Pharm Pract. 2018 Dec;26(6):534-540. doi: 10.1111/ijpp.12430. Epub 2018 Jan 4.
Medication errors are the most common type of medical errors critical care patients experience. Critical care units utilise a variety of resources to reduce medication errors; it is unknown which resources or combinations thereof are most effective in improving medication safety.
To obtain UK critical care pharmacist group consensus on the most important interventions/resources that reduce medication errors. To then classify units that participated in the PROTECTED UK study to investigate if there were significant differences in the reported pharmacist prescription intervention type, clinical impact and rates according to unit resource classification.
An e-Delphi process (three rounds) obtained pharmacist consensus on which interventions/resources were most important in the reduction of medication errors in critical care patients. The 21 units involved in the PROTECTED UK study (multicentre study of UK critical care pharmacist medicines interventions), were categorised as high-, medium- and low-resource units based on routine delivery of the final Top 5 interventions/ resources. High and low units were compared according to type, clinical impact and rate of medication interventions reported during the PROTECTED UK study.
Consensus on the Top 5 combined medication error reduction resources was established: advanced-level clinical pharmacist embedded in critical care being ranked most important. Pharmacists working on units with high resources made significantly more clinically significant medicines optimisations compared to those on low-resourced units (OR 3.09; P = 0.035).
Critical care pharmacist group consensus on the most important medication error reduction resources was established. Pharmacists working on high-resourced units made more clinically significant medicines optimisations.
用药错误是重症监护患者所经历的最常见的医疗错误类型。重症监护病房利用各种资源来减少用药错误；目前尚不清楚哪些资源或其组合在提高用药安全性方面最为有效。
就减少用药错误的最重要干预措施/资源达成英国重症监护药剂师团体共识。然后对参与英国PROTECTED研究的病房进行分类，以调查根据病房资源分类，所报告的药剂师处方干预类型、临床影响和发生率是否存在显著差异。
采用电子德尔菲法（三轮），就哪些干预措施/资源对减少重症监护患者用药错误最为重要达成药剂师共识。参与英国PROTECTED研究（英国重症监护药剂师药物干预多中心研究）的21个病房，根据最终排名前5的干预措施/资源的常规提供情况，被分类为高资源、中资源和低资源病房。根据英国PROTECTED研究期间报告的用药干预类型、临床影响和发生率，对高资源和低资源病房进行比较。
就排名前5的联合减少用药错误资源达成了共识：驻重症监护病房的高级临床药剂师被列为最重要。与低资源病房的药剂师相比，高资源病房的药剂师进行的具有临床意义的药物优化显著更多（比值比3.09；P = 0.035）。
就最重要的减少用药错误资源达成了重症监护药剂师团体共识。高资源病房的药剂师进行了更多具有临床意义的药物优化。
