Danish Center for Healthcare Improvements, Faculty of Social Science, Aalborg University, Aalborg, Denmark.
University College of Northern Denmark, Aalborg, Denmark.
Basic Clin Pharmacol Toxicol. 2018 Aug;123(2):174-181. doi: 10.1111/bcpt.12989. Epub 2018 Apr 6.
The aim of this controlled, before-and-after study in the Department of Psychiatry in a university hospital in Denmark was to examine the potential effects and characteristics of nurses reviewing psychiatric patients' medication records to identify potentially inappropriate prescriptions (PIPs). The control group and the intervention group each consisted of two bed units chosen based on patients' diagnoses and age categories. There were 396 patients (age ≥18 years) included in the study. Senior clinical pharmacology physicians performed medication reviews for all patients in the study; these medication reviews were considered gold standard. The intervention group: nurses were given a pharmacology course after which the nurses reviewed medication lists and subsequently conferred any identified PIPs with physicians. The control group: medication was reviewed as usual and nurses did not participate. Primary outcome measure was the potential difference in PIPs between the control group and the intervention group, analysed in two ways: (i) difference in mean number of PIPs and (ii) difference in number of patients exposed to ≥1 PIP, using regression analysis with an approximated difference-in-difference (DID) approach. Secondary outcome measure was characteristics of PIPs where physicians responded to nurse-identified PIPs. The DID between intervention group and control group for mean number of PIPs per patient was -0.23 (-1.07 to 0.60), and for number of patients receiving ≥1 PIP, the odds ratio was 0.61 (0.25 to 1.46). Physicians changed most prescriptions in the category interaction between drugs. Nurses could not significantly reduce the prevalence of PIPs for psychiatric patients.
这项在丹麦一所大学附属医院精神科进行的对照前后研究旨在检验护士审查精神科患者用药记录以识别潜在不适当处方（PIP）的潜在影响和特点。对照组和干预组各由两个基于患者诊断和年龄类别的床位单元组成。共有 396 名（≥18 岁）患者纳入研究。资深临床药理学医师对所有研究患者进行了药物审查；这些药物审查被认为是金标准。干预组：护士在接受药理学课程培训后，审查用药清单，并随后与医生商讨任何发现的 PIP。对照组：按常规审查用药，护士不参与。主要观察指标是对照组和干预组之间 PIP 的潜在差异，采用两种方法进行分析：（i）PIP 平均数的差异和（ii）暴露于≥1 个 PIP 的患者人数的差异，使用回归分析和近似差值差异（DID）方法。次要观察指标是医生对护士识别出的 PIP 做出反应的 PIP 特征。干预组与对照组之间 PIP 平均数的 DID 为-0.23（-1.07 至 0.60），而暴露于≥1 个 PIP 的患者人数的比值比为 0.61（0.25 至 1.46）。医生改变了药物相互作用类别中大多数处方。护士无法显著降低精神科患者 PIP 的发生率。
