College of Pharmacy, University of Georgia, Augusta, GA, and Department of Pharmacy, Augusta University Medical Center, Augusta, GA.
Department of Pharmacy, Emory Healthcare, Atlanta, GA, and College of Pharmacy, University of Georgia, Augusta, GA.
Am J Health Syst Pharm. 2019 Nov 13;76(Supplement_4):S92-S95. doi: 10.1093/ajhp/zxz213.
The purpose of this study was to characterize dynamic changes in medication regimen complexity over time in critically ill adults and to validate a modified version of the medication regimen complexity-intensive care unit (MRC-ICU) scoring tool.
A single-center, retrospective, observational chart review was conducted with a primary aim of assessing changes in medication regimen complexity over time, as measured by both the 39-item MRC-ICU scoring tool and a modified version (the mMRC-ICU) containing just 17 items. Secondary aims included validation of the mMRC-ICU and exploration of relationships between medication regimen complexity and ICU length of stay (LOS), inpatient mortality, and patient acuity. Adults admitted to a medical ICU from November 2016 through June 2017 were included. The medication regimens of a total of 130 patients were scored in order to test, modify, and validate the MRC-ICU and mMRC-ICU tools. The modified tool was validated by evaluating correlation of mMRC-ICU scores with MRC-ICU scores and with patient outcomes including patient acuity, ICU LOS, and inpatient mortality. mMRC-ICU scores were collected at 24 and 48 hours after admission and at ICU discharge to evaluate changes over time. Significant changes in medication regimen complexity over time were observed, with the highest scores observed at 24 hours after admission.
Medication regimen complexity may provide valuable insights into pharmacist activity and resource allocation. Further validation of the MRC-ICU and mMRC-ICU scoring tools in other critically ill populations and at external sites is required.
本研究旨在描述危重症成人的药物治疗方案复杂性随时间的动态变化，并验证药物治疗方案复杂性重症监护病房（MRC-ICU）评分工具的改良版本。
本研究采用单中心回顾性观察性图表回顾方法，主要目的是评估药物治疗方案复杂性随时间的变化，使用的评估工具包括 39 项 MRC-ICU 评分工具和仅包含 17 项的改良版（mMRC-ICU）。次要目的包括验证 mMRC-ICU 并探讨药物治疗方案复杂性与重症监护病房（ICU）住院时间（LOS）、住院死亡率和患者严重程度之间的关系。2016 年 11 月至 2017 年 6 月期间，收入我院内科重症监护病房的成人患者被纳入研究。共对 130 名患者的药物治疗方案进行评分，以测试、修改和验证 MRC-ICU 和 mMRC-ICU 工具。通过评估 mMRC-ICU 评分与 MRC-ICU 评分以及与患者结局（包括患者严重程度、ICU LOS 和住院死亡率）的相关性来验证改良工具。在入院后 24 小时和 48 小时以及 ICU 出院时收集 mMRC-ICU 评分，以评估随时间的变化。观察到药物治疗方案复杂性随时间显著变化，入院后 24 小时观察到的评分最高。
药物治疗方案复杂性可能为药师的活动和资源分配提供有价值的信息。需要在其他危重症人群和外部场所进一步验证 MRC-ICU 和 mMRC-ICU 评分工具。
