Koehl Jennifer, Steffenhagen Aaron, Halfpap Joe
Department of Pharmacy, 2348Massachusetts General Hospital, Boston, MA, USA.
Department of Pharmacy, 14397UW Health, Madison, WI, USA.
J Pharm Pract. 2021 Jun;34(3):459-464. doi: 10.1177/0897190019879254. Epub 2019 Oct 8.
To design and evaluate the accuracy and efficiency of a medication reconciliation workflow incorporating pharmacist home medication ordering.
Designed and implemented an admission medication reconciliation workflow that expanded the pharmacists' role to include an initial ordering of home medications. Performed a prospective, pre-post cohort analysis comparing preimplementation accuracy and efficiency data from inpatient medicine and cardiology patients to postimplementation accuracy and efficiency data from our emergency department observation unit. Accuracy for the preimplementation group was defined by the number of unintentional discrepancies identified by pharmacists between the prescriber admission orders and the reconciled home medication lists. Accuracy for the postimplementation group was defined by the prescriber acceptance of pharmacist-ordered home medications. Efficiency was measured by pharmacist time to complete the admission medication reconciliation process.
Prescribers accepted 98% of home medication orders placed by pharmacists, which correlated with a significant decrease in the occurrence of home medication orders containing a medication-related problem or discrepancy (46.4% vs 1.3%, < .0001). The mean pharmacist time spent completing medication reconciliation per admission decreased from 64 to 23 minutes ( < .0001).
Implementation of an admission process that incorporates pharmacist ordering of home medications increased prescribing accuracy and efficiency.
设计并评估纳入药剂师家庭用药医嘱的用药重整工作流程的准确性和效率。
设计并实施了一种入院用药重整工作流程，将药剂师的角色扩展到包括家庭用药的初始医嘱开具。进行了一项前瞻性的前后队列分析，比较了内科和心脏病科住院患者实施前的准确性和效率数据与急诊科观察单元实施后的准确性和效率数据。实施前组的准确性由药剂师在处方医生入院医嘱与重整后的家庭用药清单之间发现的无意差异数量来定义。实施后组的准确性由处方医生对药剂师开具的家庭用药医嘱的接受情况来定义。效率通过药剂师完成入院用药重整过程的时间来衡量。
处方医生接受了药剂师开具的98%的家庭用药医嘱，这与包含用药相关问题或差异的家庭用药医嘱发生率显著降低相关（46.4%对1.3%，P<0.0001）。每次入院药剂师完成用药重整的平均时间从64分钟减少到23分钟（P<0.0001）。
实施纳入药剂师开具家庭用药医嘱的入院流程提高了处方的准确性和效率。
