1 Duke University Hospital, Durham, NC, USA.
2 Moses H. Cone Memorial Hospital, Greensboro, NC, USA.
Ann Pharmacother. 2019 Jun;53(6):596-602. doi: 10.1177/1060028018825483. Epub 2019 Jan 17.
Although critically ill adults often have extended hospital lengths of stay and are at high risk of having medication-related adverse events, the value of medication histories in these patients remains underreported.
To assess the feasibility of performing medication histories in critically ill adults and to establish the frequency of and characterize identified discrepancies.
This prospective study included patients admitted to 4 intensive care units (ICUs) in a large academic medical center and was conducted in 2 phases. In phase 1, medication histories were conducted over a 5-week period by clinical pharmacists to assess feasibility. In phase 2, medication histories were conducted over a 3-week period by a pharmacy technician. Medication discrepancies, defined as any difference between the documented and pharmacy personnel-identified home medication list, were aggregated in both phases and adjudicated for severity.
In phase 1, 127 medication histories were completed (42.3% of admitted patients). Impaired cognition was the most common barrier encountered; however, 76% of patients were able to have a history completed if an attempt was made. In phase 2, a medication history was completed for 176 patients (58.9% of admitted patients). In aggregate, 1155 discrepancies were identified, with 78.2% of patients having a discrepancy. The median number of discrepancies per patient was 3 (interquartile range = 1-5); 11 life-threatening, 101 serious, and 326 significant discrepancies were identified. Conclusion and Relevance: A pharmacy personnel-based medication history program in the ICU is feasible and assists in the discovery of medication discrepancies with the potential for patient harm.
尽管危重症成人通常住院时间较长，且发生药物相关不良事件的风险较高，但药物史在这些患者中的价值仍未得到充分报告。
评估在危重症成人中进行药物史记录的可行性，并确定所发现差异的发生频率和特征。
这是一项前瞻性研究，纳入了一家大型学术医疗中心的 4 个重症监护病房（ICU）收治的患者，分两个阶段进行。在第 1 阶段，临床药师在 5 周内进行药物史记录，以评估可行性。在第 2 阶段，由一名药剂师技术员在 3 周内进行药物史记录。药物差异定义为记录的药物与药剂人员识别的家庭用药清单之间的任何差异，在两个阶段均进行了汇总，并对严重程度进行了裁决。
在第 1 阶段，完成了 127 份药物史记录（占入院患者的 42.3%）。认知障碍是最常见的障碍，但如果尝试进行，76%的患者仍能够完成药物史记录。在第 2 阶段，为 176 名患者（占入院患者的 58.9%）完成了药物史记录。总共发现了 1155 个差异，其中 78.2%的患者存在差异。每位患者的差异中位数为 3 个（四分位距=1-5）；发现 11 个危及生命、101 个严重和 326 个显著差异。结论和相关性：在 ICU 中实施基于药剂人员的药物史记录计划是可行的，有助于发现可能对患者造成伤害的药物差异。
