Falconer Nazanin, Liow Doreen, Zeng Irene, Parsotam Nirasha, Seddon Mary, Nand Sanjoy
School of Pharmacy (PACE), University of Queensland, Brisbane, Queensland, Australia.
Pharmacy Service, Middlemore Hospital, Auckland, New Zealand.
Eur J Hosp Pharm. 2017 Nov;24(6):320-326. doi: 10.1136/ejhpharm-2016-001165. Epub 2017 May 16.
Adverse drug events (ADEs) pose a heavy burden on health systems worldwide. The assessment of risk tool (ART) was developed to help prioritise hospitalised patients for interventions such as medication reconciliation (MR) and review, and to reduce potential ADEs from unintentional medication discrepancies and prescribing errors.
To validate ART, and to determine which of the selected 25 flags were significantly associated with risk of unintentional medication discrepancies and prescribing errors.
This was a prospective observational study of 247 admissions to two medical teams in a New Zealand hospital. Study pharmacists undertook MR and review for all eligible admissions over 5 months. A Kruskal-Wallis test was used to determine differences in numbers of unintentional medication discrepancies and prescribing errors, followed by generalised linear modelling, to find the estimated ratio of the mean number of unintentional medication discrepancies between the three ART groups. In part 2 of the study, using multivariable logistic regression, combinations of flags significantly associated with risk were identified.
Significant differences in the number of unintentional medication discrepancieswere found between the ART risk groups (p<0.0001, Kruskal-Wallis test). Patients in the high-risk group had a significantly greater number of unintentional medication discrepancies than those in the medium- and low-risk groups. There were no significant differences in prescribing errors between the ART risk groups (p=0.08, Kruskal-Wallis test). Flags significantly associated with risk, included 'more than eight admission medications', OR=3.7 (95% CI 2.2 to 6.4) and 'readmission within 30 days', OR=6.8 (95% CI 3.0 to 15.2), p<0.0001.
ART was effective for prioritising patients for interventions such as MR.
药物不良事件（ADEs）给全球卫生系统带来沉重负担。风险评估工具（ART）的开发旨在帮助确定住院患者接受诸如用药核对（MR）和审查等干预措施的优先级，并减少因无意的用药差异和处方错误导致的潜在药物不良事件。
验证ART，并确定所选的25个标记中哪些与无意的用药差异和处方错误风险显著相关。
这是一项对新西兰一家医院两个医疗团队的247例入院患者进行的前瞻性观察研究。研究药师在5个月内对所有符合条件的入院患者进行了用药核对和审查。使用Kruskal-Wallis检验确定无意用药差异和处方错误数量的差异，随后进行广义线性建模，以找出三个ART组之间无意用药差异平均数的估计比率。在研究的第二部分，使用多变量逻辑回归确定与风险显著相关的标记组合。
ART风险组之间无意用药差异数量存在显著差异（p<0.0001，Kruskal-Wallis检验）。高风险组患者的无意用药差异数量明显多于中风险组和低风险组。ART风险组之间的处方错误没有显著差异（p=0.08，Kruskal-Wallis检验）。与风险显著相关的标记包括“入院用药超过8种”，OR=3.7（95%CI 2.2至6.4）和“30天内再次入院”，OR=6.8（95%CI 3.0至15.2），p<0.0001。
ART对于确定患者接受诸如用药核对等干预措施的优先级是有效的。
