Solano Sarah, Dow Jordan, Audley Terry, Bangalore Nitish
P T. 2019 Jan;44(2):64-68.
In 2013, formulary medications were aligned among the three hospitals within our health system. However, as formulary medication restrictions were not aligned, the three hospitals continued to have inconsistent medication restrictions. This led to confusion among prescribers and pharmacists about which medications were restricted, what the restrictions were, and where to access information about the restrictions. To alleviate this confusion, we set out to align formulary restrictions and to provide medication restriction details at the points of entering and verifying medication orders.
The primary objective was to align 100% of the formulary medication restrictions at our health system. The secondary objectives were to improve ease of access to restriction information and to improve the clarity of medication restrictions for pharmacists.
The process of alignment involved completing a gap analysis to identify differences between each site's medication restrictions and site-specific interventions. The gap analysis, proposed restrictions, and proposed interventions were reviewed by the system's pharmacy, nutrition, and therapeutics (PNT) planning committee. The committee reviewed each medication, the restrictions, and the proposed modifications. The consensus of formulary medication restrictions was presented to the PNT committee for approval. Restriction information was added to each drug monograph in the online medication information database and the interventions were built into the electronic medical record (EMR). Five intervention types were included: restriction removal, "outpatient use only" added to the medication name, order-specific questions, alternative alerts, and information put into order instructions seen by both ordering providers and verifying pharmacists. Pharmacists were educated about the restricted medication-alignment initiative. A survey was administered after education to assess the ease of access to restricted medication information and clarity of medication restrictions. Because of the scope of this project, education and survey administration was limited to pharmacists only.
Aligned medication restrictions increased from 11% to 100%. Of the 110 medication restrictions that were not aligned, 17 restrictions were removed, 37 medications were restricted to outpatient use only, and 56 restricted medications were further aligned across the health system. Results from the survey showed that more pharmacists utilized the online medication information database to find information regarding restricted medications and that it was easier for more pharmacists to find this information.
2013年，我们医疗系统内的三家医院统一了处方药物。然而，由于处方药物限制未统一，这三家医院的用药限制仍然不一致。这导致开处方者和药剂师对于哪些药物受限、限制是什么以及从何处获取有关限制的信息感到困惑。为了缓解这种困惑，我们着手统一处方限制，并在录入和核实用药医嘱时提供用药限制细节。
主要目标是使我们医疗系统内100%的处方药物限制保持一致。次要目标是提高获取限制信息的便利性，并提高药剂师对用药限制的清晰度。
统一过程包括完成差距分析，以确定各机构用药限制与特定机构干预措施之间的差异。系统的药学、营养与治疗学（PNT）规划委员会对差距分析、提议的限制措施和提议的干预措施进行了审查。该委员会审查了每种药物、限制措施和提议的修改内容。处方药物限制的共识提交给PNT委员会批准。限制信息被添加到在线用药信息数据库中的每个药品专著中，干预措施被纳入电子病历（EMR）。包括五种干预类型：取消限制、在药物名称中添加“仅门诊使用”、特定医嘱问题、替代警报以及将信息放入医嘱说明中供开医嘱者和核实药剂师查看。药剂师接受了关于受限药物统一倡议的培训。培训后进行了一项调查，以评估获取受限药物信息的便利性和用药限制的清晰度。由于该项目的范围，培训和调查仅针对药剂师进行。
统一的用药限制从11%增加到了100%。在110项未统一的用药限制中，17项限制被取消，37种药物被限制为仅门诊使用，56种受限药物在整个医疗系统中进一步实现了统一。调查结果显示，更多的药剂师利用在线用药信息数据库查找有关受限药物的信息，并且更多的药剂师更容易找到这些信息。
