Gesundheit Nordhessen Holding AG - Pharmacy, Moenchebergstr. 41-43, 34125, Kassel, Germany.
Faculty of Pharmacy, Institute of Pharmacology and Clinical Pharmacy, University of Marburg, Karl-von-Frisch Str. 1, 35032, Marburg, Germany.
Int J Clin Pharm. 2019 Oct;41(5):1184-1192. doi: 10.1007/s11096-019-00874-8. Epub 2019 Jul 22.
Background With a clinical pharmacists' participation in an intensive care unit (ICU) previous international studies have shown a reduction of medication errors, drug costs and improvements of clinical outcomes. Still there is a lack of qualitative data on clinical pharmacists' impact on prescribing error rates in the ICU. Therefore, a new approach was developed relating prescribing errors to the number of monitored medications including physicians' approval on all prescribing errors. Objective This study investigates the influence of clinical pharmacists' medication review on the prescribing error rate in an ICU. Setting A controlled interventional study was conducted in a surgical ICU with one control phase (P0) and two intervention phases (P1 and P2). Method The investigation aimed to determine if the medication review by clinical pharmacists results in a significant reduction of prescribing errors related to a control period. In contrast to previous studies, prescribing errors detected by the clinical pharmacists, were only taken into account, if consent with the physicians was achieved. Secondary outcomes were the reduction of potentially severe prescribing errors, the number of days without systemic anti-infective therapy and the ICU length of stay. Throughout P0 the data was collected retrospectively without any intervention. During the intervention periods P1 and P2, two clinical pharmacists screened the medical records for prescribing errors and discussed them with the senior physician in charge. During P2 one clinical pharmacist attended ward rounds additionally. Main Outcome Measure The main outcome measure of this study was the number of prescribing errors detected related to the number of monitored medications. Results The incidence of prescribing errors was significantly reduced from 1660 in P0 to 622 in P1 respectively 401 in P2 (P0 vs. P1/P2 respectively; both p < 0.001; Fisher's Exact Test) in total, respective 14.12% in P0 vs. 5.13% in P1 and 3.25% in P2 related to the monitored medications (P0:11755; P1:12134; P2:12329). Conclusion Clinical pharmacists' interventions led to a significant reduction of prescribing errors in the ICU, contributing to a safer medication process. We strongly recommend a broad implementation of clinical pharmacists in ICUs.
在重症监护病房（ICU）中，临床药师的参与已被多项国际研究证实可减少用药错误、降低药物成本并改善临床结局。然而，关于临床药师对 ICU 中处方错误率的影响，仍缺乏定性数据。因此，我们开发了一种新方法，将处方错误与监测药物的数量联系起来，包括医生对所有处方错误的认可。目的：本研究旨在调查 ICU 中临床药师进行药物审查对处方错误率的影响。设置：在一个外科 ICU 中进行了一项对照干预研究，包括一个对照阶段（P0）和两个干预阶段（P1 和 P2）。方法：研究旨在确定临床药师进行药物审查是否可显著降低与对照期相关的处方错误。与以往的研究不同，只有在与医生达成一致的情况下，临床药师发现的处方错误才被考虑在内。次要结局包括潜在严重处方错误的减少、无全身抗感染治疗的天数和 ICU 住院时间。在 P0 期间，数据是回顾性收集的，没有任何干预。在干预阶段 P1 和 P2 期间，两名临床药师筛查了病历中的处方错误，并与负责的主治医生进行了讨论。在 P2 期间，一名临床药师还参加了查房。主要观察指标：本研究的主要观察指标是检测到的与监测药物数量相关的处方错误数量。结果：与 P0 相比，P1 分别为 622 例和 P2 为 401 例时（P0 与 P1/P2 相比；均 p < 0.001；Fisher 精确检验），处方错误的发生率显著降低，共 1660 例，分别为 14.12%在 P0 中，与监测药物相关的分别为 5.13%在 P1 中，3.25%在 P2 中（P0：11755；P1：12134；P2：12329）。结论：临床药师的干预措施显著降低了 ICU 中的处方错误，有助于提高药物使用的安全性。我们强烈建议在 ICU 中广泛实施临床药师。
