Schepel Lotta, Lehtonen Lasse, Airaksinen Marja, Ojala Raimo, Ahonen Jouni, Lapatto-Reiniluoto Outi
HUS Pharmacy, Hospital Pharmacy of Helsinki University Hospital (HUS), Finland.
Specialization Programme of Hospital and Health Centre Pharmacy, Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Finland.
Int J Risk Saf Med. 2019;30(1):19-31. doi: 10.3233/JRS-180030.
10-30% of hospital stays by older patients are drug-related. The admission phase is important for identifying drug-related problems, but taking an incorrect medication history often leads to medication errors.
To enhance medication history recording and identify drug-related problems (DRPs) of older patients admitted to emergency departments (EDs).
DRPs were identified by pharmacists-led medication reconciliation and review procedures in two EDs in Finland; Helsinki University Hospital (HUS), and Kuopio University Hospital (KUH). One-hundred-and-fifty patients aged ≥65-years, living at home and using ≥6 medicines were studied.
100% of patients (N = 75) in HUS and 99% in KUH (N = 75), had discrepancies in their admission-medication chart recorded by the nurse or physician. Associations between admission-diagnosis and drug-related problems were found in 12 patients (16%) in HUS and 22 patients (29%) in KUH. Of these, high-alert medications (e.g. antithrombotics, cytostatics, opioids) were linked to eight patients (11%) in HUS and six patients (8%) in KUH. Other acute DRPs were identified in 19 patients (25%) in HUS and 54 patients (72%) in KUH. Furthermore, 67 patients (89%) in HUS and all patients in KUH had non-acute DRPs.
Medication reconciliation and review at admission of older ED patients requires improvement in Finland.
老年患者住院期间10%-30%与药物相关。入院阶段对于识别药物相关问题很重要，但获取错误的用药史往往会导致用药错误。
加强用药史记录并识别急诊入院老年患者的药物相关问题（DRP）。
在芬兰的两家急诊室，即赫尔辛基大学医院（HUS）和库奥皮奥大学医院（KUH），由药剂师主导的用药核对与审查程序来识别DRP。研究了150名年龄≥65岁、居家且使用≥6种药物的患者。
HUS的100%患者（N = 75）和KUH的99%患者（N = 75），护士或医生记录的入院用药图表存在差异。HUS的12名患者（16%）和KUH的22名患者（29%）发现入院诊断与药物相关问题之间存在关联。其中，高警示药物（如抗血栓药、细胞毒性药物、阿片类药物）与HUS的8名患者（11%）和KUH的6名患者（8%）有关。HUS的19名患者（25%）和KUH的54名患者（72%）还发现了其他急性DRP。此外，HUS的67名患者（89%）和KUH的所有患者都存在非急性DRP。
在芬兰，老年急诊患者入院时的用药核对与审查需要改进。
