Clinical Pharmacy Division, Department of Pharmacy, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan.
Br J Clin Pharmacol. 2019 Nov;85(11):2614-2622. doi: 10.1111/bcp.14095. Epub 2019 Sep 15.
The aim of this study was to improve medication reconciliation and reduce the occurrence of duplicate prescriptions by pharmacists and physicians within 72 hours of hospital admission using an intelligent prescription system combined with the National Health Insurance PharmaCloud system to integrate the database with the medical institution computerized physician order entry (CPOE) system.
This 2-year intervention study was implemented in the geriatric ward of a hospital in Taiwan. We developed an integrated CPOE system linked with the PharmaCloud database and established an electronic platform for coordinated communication with all healthcare professionals. Patients provided written informed consent to access their PharmaCloud records. We compared the intervention effectiveness within 72 hours of admission for improvement in pharmacist medication reconciliation, increased at-home medications documentation and decreased costs from duplicated at-home prescriptions.
The medication reconciliation rate within 72 hours of admission increased from 44.0% preintervention to 86.8% postintervention (relative risk = 1.97, 95% confidence interval [CI]: 1.69-2.31; P < .001). The monthly average of patients who brought and took home medications documented in the CPOE system during hospitalization increased by 7.54 (95% CI 5.58-20.49, P = .22). The monthly average of home medications documented increased by 102.52 (95% CI 38.44-166.60; P = .01). Savings on the monthly average prescription expenditures of at-home medication increased by US$ 2,795.52 (95% CI US$1310.41-4280.63; P < .01).
Integrating medication data from PharmaCloud to the hospital's medical chart system improved pharmacist medication reconciliation, which decreased duplicated medications and reduced in-hospital medication costs.
本研究旨在通过将 PharmaCloud 系统与医院的电子病历系统整合，利用智能处方系统，在患者入院 72 小时内，由药师和医师共同提高用药医嘱核对的准确率，并减少重复用药医嘱。
这项为期 2 年的干预研究在台湾一家医院的老年病房进行。我们开发了一个与 PharmaCloud 数据库整合的综合电子病历系统，并建立了一个与所有医疗保健专业人员协调沟通的电子平台。患者签署了书面知情同意书，以访问他们的 PharmaCloud 记录。我们比较了入院 72 小时内的干预效果，以提高药师对用药医嘱的核对准确率、增加在家中服用的药物记录，并降低因重复开具在家中服用的药物而产生的费用。
入院 72 小时内的用药医嘱核对准确率从干预前的 44.0%提高到了干预后的 86.8%（相对风险=1.97，95%置信区间[CI]：1.69-2.31；P<0.001）。在电子病历系统中记录患者在住院期间带回家服用的药物的月平均人数增加了 7.54（95%CI 5.58-20.49，P=0.22）。记录在家中服用的药物的月平均人数增加了 102.52（95%CI 38.44-166.60；P=0.01）。在家中服用的药物的每月平均处方支出减少了 2795.52 美元（95%CI 1310.41-4280.63；P<0.01）。
将 PharmaCloud 的用药数据整合到医院的电子病历系统中，提高了药师对用药医嘱的核对准确率，减少了重复用药医嘱，并降低了住院期间的用药费用。
