Arenas-Villafranca José Javier, Rodríguez-Camacho Juan Manuel, Pérez-Moreno María Antonia, Moreno-Santamaría Manuela, Martos-Pérez Francisco de Asís, Tortajada-Goitia Begoña
Department of Pharmacy and Nutrition, Costa Del Sol Hospital, Marbella, Malaga, Spain.
Department of Pharmacy, Son Llàtzer Hospital, Palma de Mallorca, Balearic Island, Spain.
Eur J Hosp Pharm. 2018 Mar;25(e1):e59-e61. doi: 10.1136/ejhpharm-2017-001339. Epub 2017 Nov 9.
To describe a clinical pharmacist's (CP) activity in an emergency department (ED) regarding medication reconciliation and optimisation of pharmacotherapy of patients at hospital admission.
A 1-year prospective observational study was conducted to analyse the activity of a CP in the ED of a 350-bed hospital in Spain. The CP reviewed home medications and medical prescriptions of patients to perform medication reconciliation if required and intervene if medication errors were detected.
The CP reviewed medications and medical orders of 1048 patients. 816 patients had home medication: 440 patients (53.9%) were correctly reconciled by the physician; 136 (16.7%) were reconciled by the physician with unintentional discrepancies; and 240 (29.4%) by the CP, with a higher percentage in patients admitted to surgical departments (χ:38.698; P<). Following pharmaceutical validation, 434 pharmaceutical interventions were performed.
The presence of a CP in an ED could increase the detection of reconciliation errors and help resolve medication errors.
描述临床药师（CP）在急诊科（ED）针对患者入院时的用药核对及药物治疗优化所开展的活动。
开展了一项为期1年的前瞻性观察性研究，以分析西班牙一家拥有350张床位医院的急诊科中临床药师的活动。临床药师会审查患者的家庭用药及医嘱，必要时进行用药核对，若发现用药错误则进行干预。
临床药师审查了1048例患者的用药及医嘱。816例患者有家庭用药：440例患者（53.9%）经医生正确核对；136例（16.7%）经医生核对但存在无意差异；240例（29.4%）经临床药师核对，其中外科住院患者的比例更高（χ：38.698；P<）。经过药学验证后，进行了434次药学干预。
急诊科配备临床药师可增加对核对错误的发现，并有助于解决用药错误问题。
