Bonnerup Dorthe Krogsgaard, Lisby Marianne, Sædder Eva Aggerholm, Brock Birgitte, Truelshøj Tania, Sørensen Charlotte Arp, Pedersen Anita Gorm, Nielsen Lars Peter
Hospital Pharmacy, Central Denmark Region, Randers Regional Hospital, Dronningborg Boulevard 16D, DK-8930 Randers NØ, Denmark.
Research Centre for Emergency Medicine, Aarhus University Hospital, Denmark.
Ther Adv Drug Saf. 2020 Sep 20;11:2042098620957142. doi: 10.1177/2042098620957142. eCollection 2020.
Patients at high risk of medication errors will potentially benefit most from medication reviews. An algorithm, MERIS, can identify the patients who are at highest risk of medication errors. The aim of this study was to examine the effects of performing stratified medication reviews on patients who according to MERIS were at highest risk of medication errors.
A randomised controlled trial was performed at the Acute Admissions Unit, Aarhus University Hospital, Denmark. Patients were included at admission to the hospital and were randomised to control or intervention. The intervention consisted of stratified medication review at admission on patients with a high MERIS score. Clinical pharmacists and clinical pharmacologists performed the medication reviews; the clinical pharmacologists performed the reviews on patients with the highest MERIS score. The primary outcome measure was the number of prescribing errors during the hospitalisation. Secondary outcomes included self-experienced quality of life, health-care utilisation and mortality measured at follow-up 90 days after discharge.
A total of 375 patients were included, of which medication reviews were performed in 64 patients. The medication reviews addressed 63 prescribing errors in 37 patients and 60 other drug-related problems. No difference in the number of prescribing errors during hospitalisation between the intervention group ( = 165) and control group ( = 153) was found, corresponding to 0.11 prescribing errors per drug (95% confidence interval (CI): 0.08-0.14) 0.13 per drug (95% CI: 0.09-0.16), respectively. No differences in secondary outcomes were observed.
A stratified medication review approach based on the individual patient's risk of medication errors did not show impact on the chosen outcomes.
Patients are at risk of medication errors at admission to hospital. Medication reviews aim to detect and solve these. Yet, due to limited resources in healthcare, it would be beneficial to detect the patients who are most at risk of medication errors and perform medication reviews on those patients.In this study we investigated whether an algorithm, MERIS, could detect patients who are at highest risk of medication errors; we also studied whether performing medication reviews on patients at highest risk of medication errors would have an effect on, for example, the number of medication errors during hospitalisation, qualify of life and number of readmissions. We included 375 patients in a Danish acute admission unit and they were divided into control group and intervention group. Patients in the intervention group received a medication review at admission if they were considered at high risk of medication errors, assessed with the aid of MERIS. In summary, 64 patients in the intervention group were most at risk of medication errors and therefore received a medication review.We conclude in the study that MERIS was useful in identifying relevant patients for medication reviews. Yet, the medication reviews performed at admission did not impact on the chosen outcomes.
用药错误高风险患者可能从用药评估中获益最多。一种名为MERIS的算法能够识别出用药错误风险最高的患者。本研究的目的是检验对那些根据MERIS被判定为用药错误风险最高的患者进行分层用药评估的效果。
在丹麦奥胡斯大学医院急性入院科进行了一项随机对照试验。患者在入院时被纳入研究，并被随机分为对照组或干预组。干预措施包括对MERIS评分高的患者在入院时进行分层用药评估。临床药剂师和临床药理学家进行用药评估；临床药理学家对MERIS评分最高的患者进行评估。主要结局指标是住院期间的处方错误数量。次要结局包括出院后90天随访时自我体验的生活质量、医疗保健利用情况和死亡率。
共纳入375例患者，其中64例患者接受了用药评估。用药评估发现37例患者存在63处处方错误以及60个其他与药物相关的问题。未发现干预组（n = 165）和对照组（n = 153）住院期间处方错误数量存在差异，分别相当于每种药物0.11处处方错误（95%置信区间（CI）：0.08 - 0.14）和0.13处处方错误（95% CI：0.09 - 0.16）。未观察到次要结局存在差异。
基于个体患者用药错误风险的分层用药评估方法对所选结局未显示出影响。
患者在入院时存在用药错误风险。用药评估旨在检测并解决这些问题。然而，由于医疗保健资源有限，识别出用药错误风险最高的患者并对这些患者进行用药评估将是有益的。在本研究中，我们调查了MERIS算法是否能够检测出用药错误风险最高的患者；我们还研究了对用药错误风险最高的患者进行用药评估是否会对例如住院期间的用药错误数量、生活质量和再入院次数产生影响。我们在丹麦一个急性入院科纳入了375例患者，并将他们分为对照组和干预组。干预组中如果患者被认为用药错误风险高（借助MERIS进行评估），则在入院时接受用药评估。总之，干预组中有64例患者用药错误风险最高，因此接受了用药评估。我们在研究中得出结论，MERIS有助于识别适合进行用药评估的相关患者。然而，入院时进行的用药评估对所选结局没有影响。
