Craynon Ryan, Hager David R, Reed Mike, Pawola Julie, Rough Steve S
Department of Pharmacy, University of Wisconsin Health, Madison, WI
Department of Pharmacy, University of Wisconsin Health, Madison, WI.
Am J Health Syst Pharm. 2018 Oct 1;75(19):1486-1492. doi: 10.2146/ajhp170638. Epub 2018 Jul 5.
Results of a pilot project to improve the safety and efficiency of the discharge process by adding daily pharmacist review and preparation of discharge medication orders to an existing discharge medication reconciliation workflow are reported.
Due to patient capacity issues, the pharmacy department of a large tertiary medical center implemented changes to the existing medication discharge workflow. A steering committee was established, with subgroups responsible for workflow development, electronic medical record enhancement, and data collection designated. Patients admitted to 5 hospitalist services, 1 otolaryngology service, and 1 gynecology service were included in pilot testing of a new discharge workflow over a 7-week period. The new workflow included pharmacist daily prospective preparation of discharge medication orders by "pending" (i.e., managing all aspects of) orders for providers to sign. After implementation, a 22% relative reduction ( = 0.046) in pharmacist-identified medication-related problems was documented. Additionally, the proportion of discharges occurring before noon was increased on all services involved in the pilot project, including a significant increase (from 19% to 23%, = 0.001) on the hospitalist services. Challenges identified during the pilot project included suboptimal initial provider acceptance and added pharmacist workload. On average, an additional 16.2 minutes of pharmacist time per patient was required for ordering of discharge medications throughout a patient stay.
Implementation of a discharge process that incorporated pharmacist pending of discharge medication orders throughout the patient stay improved measures of safety and efficiency of the discharge process.
报告一项试点项目的结果，该项目通过在现有的出院用药核对工作流程中增加药师每日对出院用药医嘱的审核和准备工作，来提高出院流程的安全性和效率。
由于患者容量问题，一家大型三级医疗中心的药房部门对现有的用药出院工作流程进行了更改。成立了一个指导委员会，指定了负责工作流程开发、电子病历改进和数据收集的子小组。在7周的时间里，纳入了5个内科住院医师服务科室、1个耳鼻喉科服务科室和1个妇科服务科室收治的患者，对新的出院工作流程进行试点测试。新工作流程包括药师每日前瞻性地准备出院用药医嘱，通过“待处理”（即管理各方面）医嘱供医生签署。实施后，记录到药师识别出的与用药相关问题相对减少了22%（P = 0.046）。此外，参与试点项目的所有服务科室中，中午之前出院的比例都有所增加，在内科住院医师服务科室中增加显著（从19%增至23%，P = 0.001）。试点项目中发现的挑战包括最初医生的接受度欠佳以及药师工作量增加。在患者住院期间，为每位患者开具出院用药平均需要药师额外花费16.2分钟。
实施一种在患者住院期间纳入药师对出院用药医嘱进行待处理的出院流程，改善了出院流程的安全性和效率指标。
