George Doris, Supramaniam Nirmala D, Hamid Siti Q Abd, Hassali Mohamad A, Lim Wei-Yin, Hss Amar-Singh
Pharmacy Department, Raja Permaisuri Bainun Hospital; &. Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia. Penang (Malaysia).
Pharmacy Department, Raja Permaisuri Bainun Hospital. Perak (Malaysia).
Pharm Pract (Granada). 2019 Jul-Sep;17(3):1501. doi: 10.18549/PharmPract.2019.3.1501. Epub 2019 Aug 21.
Patients requiring medications during discharge are at risk of discharge medication errors that potentially cause readmission due to medication-related events.
The objective of this study was to develop interventions to reduce percentage of patients with one or more medication errors during discharge.
A pharmacist-led quality improvement (QI) program over 6 months was conducted in medical wards at a tertiary public hospital. Percentage of patients discharge with one or more medication errors was reviewed in the pre-intervention and four main improvements were developed: increase the ratio of pharmacist to patient, prioritize discharge prescription order within office hours, complete discharge medication reconciliation by ward pharmacist, set up a Centralized Discharge Medication Pre-packing Unit. Percentage of patients with one or more medication errors in both pre- and post-intervention phase were monitored using process control chart.
With the implementation of the QI program, the percentage of patients with one or more medication errors during discharge that were corrected by pharmacists significantly increased from 77.6% to 95.9% (p<0.001). Percentage of patients with one or more clinically significant error was similar in both pre and post-QI with an average of 24.8%.
Increasing ratio of pharmacist to patient to complete discharge medication reconciliation during discharge significantly recorded a reduction in the percentage of patients with one or more medication errors.
出院时需要药物治疗的患者存在出院用药错误的风险，这可能会因药物相关事件导致再次入院。
本研究的目的是制定干预措施，以降低出院时出现一种或多种用药错误的患者比例。
在一家三级公立医院的内科病房开展了一项由药剂师主导的为期6个月的质量改进（QI）项目。在干预前对出院时出现一种或多种用药错误的患者比例进行了评估，并制定了四项主要改进措施：提高药剂师与患者的比例、在办公时间内优先处理出院处方、由病房药剂师完成出院用药核对、设立集中式出院药物预包装单元。使用过程控制图监测干预前和干预后阶段出现一种或多种用药错误的患者比例。
随着QI项目的实施，药剂师纠正的出院时出现一种或多种用药错误的患者比例从77.6%显著增加到95.9%（p<0.001）。在QI前后，出现一种或多种具有临床意义错误的患者比例相似，平均为24.8%。
在出院时提高药剂师与患者的比例以完成出院用药核对，显著降低了出现一种或多种用药错误的患者比例。
