Loustalot Marie-Caroline, Berdot Sarah, Sabatier Pierre, Durieux Pierre, Perrin Germain, Karras Alexandre, Sabatier Brigitte
Pharmacy Department, Georges-Pompidou European Hospital, APHP, Paris, France.
Pharmacy Department, Georges-Pompidou European Hospital, APHP, Paris, France / Equipe 22, Centre de Recherche des Cordeliers, UMR, INSERM, Paris, France / Paris-Sud University, Faculty of Pharmacy, Clinical Pharmacy Department, Châtenay Malabry, France.
Swiss Med Wkly. 2019 Feb 15;149:w20015. doi: 10.4414/smw.2019.20015. eCollection 2019 Feb 11.
This study assesses clinical interventions by pharmacists prospectively collected from medical and surgical wards, notably the acceptance of interventions, computerised physician order entry (CPOE)related problems, the potential impact of interventions on patient safety evaluated by a multidisciplinary committee, and their evolution over the 10 years since a first assessment.
A prospective observational study covering 13 months was conducted in a French teaching hospital with a patient information system that integrates an electronic health record (EHR) with a CPOE. Interventions by pharmacists were prospectively recorded using CPOE. All interventions were reviewed by two pharmacists. We assessed the interventions, the possible implications of the CPOE in prescribing errors, and the acceptance of interventions by physicians. A committee reviewed the potential clinical impact for patients. The results were compared with the same outcomes collected 10 years ago in the same hospital.
A total of 2141 interventions by pharmacists were reviewed. Among them, 1589 (74.1%) were accepted by physicians. Regarding the potential clinical impact, a total of 1136 (53%) interventions concerned prescriptions that were potentially significant or serious for patients and 42 (2%) of them were potentially life-threatening. Ten years earlier, the acceptance rate was 23%. Moreover, 14.7% of errors were attributed to the use of the software, whereas 10 years earlier the rate of errors was 49%.
The acceptance rate and frequency of CPOE-related errors were better than 10 years before, which is encouraging and shows the importance of regular training and collaboration with healthcare givers to reduce errors. The routine analysis of interventions by pharmacists with medical staff feedback should continue to improve their relevance and effectiveness.
本研究评估了从内科和外科病房前瞻性收集的药剂师的临床干预措施，特别是干预措施的接受情况、与计算机化医嘱录入（CPOE）相关的问题、多学科委员会评估的干预措施对患者安全的潜在影响，以及自首次评估以来10年中的变化情况。
在一家法国教学医院进行了一项为期13个月的前瞻性观察研究，该医院的患者信息系统将电子健康记录（EHR）与CPOE集成在一起。使用CPOE前瞻性记录药剂师的干预措施。所有干预措施均由两名药剂师进行审查。我们评估了干预措施、CPOE在处方错误方面的可能影响以及医生对干预措施的接受情况。一个委员会审查了对患者的潜在临床影响。将结果与10年前在同一家医院收集的相同结果进行比较。
共审查了药剂师的2141项干预措施。其中，1589项（74.1%）被医生接受。关于潜在的临床影响，共有1136项（53%）干预措施涉及对患者可能具有重大或严重意义的处方，其中42项（2%）可能危及生命。10年前，接受率为23%。此外，14.7%的错误归因于软件的使用，而10年前错误率为49%。
CPOE相关错误的接受率和发生率比10年前有所改善，这令人鼓舞，并表明定期培训以及与医护人员合作以减少错误的重要性。药剂师在获得医务人员反馈的情况下对干预措施进行常规分析应继续提高其相关性和有效性。
