Alomar Mukhtar Jawad, Ahmad Sohail, Moustafa Yahya, Alharbi Lafi Salim
Department of Pharmacy Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
Department of Clinical Pharmacy, MAHSA University, Kuala Langat, Selangor, Malaysia.
J Res Pharm Pract. 2020 Mar 28;9(1):36-43. doi: 10.4103/jrpp.JRPP_19_95. eCollection 2020 Jan-Mar.
The objectives of this study were to investigate the frequency and reasons for missing doses and impact of a pharmacist-led intervention to reduce the missed doses in intensive care units.
This study was completed in two phases. In the first phase, a retrospective quality assurance audit was conducted to quantify the problem of missed doses from the pharmacist/nurse communication slip record. The frequency and potential reasons for missing dose occurrences were identified and listed, and respective solutions were finalized by a joint health-care team. In the second phase of the study, post-intervention analysis was done for a period of 1 month to check the impact of intervention. The data were recorded from pharmacy/nursing communication forms for medication, dosage form, route of administration (ROA), frequency of missed doses, and underlying reasons for missing doses.
There was a substantial reduction in the number of incidences of missed doses in post-intervention phase. The number of events decreased from 190 (pre-intervention; 2 months) to 11 (post-intervention; 1 month), 389 to 87, and 133 to 12 for automatic stop order, unknown reason, and late mix medication, respectively. No missed dose event was recorded secondary to order overseen and inactive patient status in post-intervention phase. Moreover, identified reasons, ROA, frequency, and the system status were the significant predictors of missing doses.
The findings of this study emphasized the need to introduce better documentation procedures and continuous surveillance system to decrease the number of missing doses and further improve already established drug distribution service.
本研究的目的是调查重症监护病房漏服药物的频率、原因以及由药剂师主导的减少漏服药物干预措施的影响。
本研究分两个阶段完成。在第一阶段，进行了一项回顾性质量保证审核，以根据药剂师/护士沟通记录单量化漏服药物问题。确定并列出漏服药物发生的频率和潜在原因，由联合医疗团队确定各自的解决方案。在研究的第二阶段，进行了为期1个月的干预后分析，以检查干预措施的影响。从药房/护理沟通表格中记录药物、剂型、给药途径（ROA）、漏服药物频率以及漏服药物的根本原因等数据。
干预后阶段漏服药物的发生率大幅降低。自动停止医嘱、原因不明和混合药物延迟的事件数量分别从190起（干预前；2个月）降至11起（干预后；1个月）、从389起降至87起以及从133起降至12起。干预后阶段未记录到因医嘱监督和患者无活动状态导致的漏服药物事件。此外，确定的原因、给药途径、频率和系统状态是漏服药物的重要预测因素。
本研究结果强调需要引入更好的记录程序和持续监测系统，以减少漏服药物的数量，并进一步改善已建立的药品分发服务。
