PGY1/PGY2 MS Health System Pharmacy Administration Resident, Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Specialty Practice Pharmacist - Emergency Medicine, Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Am J Emerg Med. 2021 Oct;48:288-294. doi: 10.1016/j.ajem.2021.04.054. Epub 2021 May 1.
BACKGROUND/PURPOSE: Little data has been published regarding emergency medicine pharmacist (EMP) review of discharge prescriptions. An internal retrospective review of a limited sample size of emergency department (ED) discharge prescriptions demonstrated a 13.6% potential intervention rate by EMPs. With this information, it was postulated that EMPs could provide a valuable service via a process of targeted review of ED discharge prescriptions that would yield intervention rates higher than the internal audit. The aim of this project was therefore to develop a real-time notification system within the electronic health record (EHR) for targeted discharge prescription review, to establish an associated EMP workflow, and to evaluate the intervention rate achieved through targeted discharge prescription review.
This was a single-center, retrospective review of the implementation of a new pharmacist-driven clinical service over a 12 week period from February 19th, 2018 to May 14th, 2018. Criteria for prescription review were determined after an internal audit by the EMPs and included an assessment of established high-alert medications. Discharge prescriptions that met the inclusion criteria were filtered into a real-time work queue in the EHR for EMP review. When necessary, EMPs discussed recommendations with prescribers, or adjusted prescriptions according to institutional pharmacist privileges. Interventions were reviewed and categorized to assess rate of intervention and the types of medication-related problems (MRPs) identified.
EMPs reviewed 378 discharge prescriptions and a total of 158 prescriptions were identified as having at least one MRP. Of these, 70 prescriptions were intervened upon thereby resulting in an 18.5% intervention rate. The most common interventions included a change in the dose/frequency, duration/refills of the medication, and patient education. The highest number of interventions were made for anticoagulant and antiinfective agents.
Utilization of a real-time notification system for prospective ED discharge prescription review is feasible. Using targeted criteria for review, pharmacists intervened on 18.5% of prescriptions reviewed. Prospective discharge prescription review by EMPs using a real-time notification system within the electronic health record identified opportunities for the pharmacist to ensure safe and optimal prescribing.
背景/目的：关于急诊药师（EMP）对出院医嘱的审查，相关数据资料较少。对急诊科（ED）出院医嘱进行了一项内部回顾性研究，结果显示 EMP 有 13.6%的潜在干预率。有了这些信息，我们推测 EMP 可以通过对 ED 出院医嘱进行有针对性的审查来提供有价值的服务，从而获得高于内部审核的干预率。因此，本项目旨在开发电子病历（EHR）中的实时通知系统，以实现有针对性的出院处方审查，并建立相关 EMP 工作流程，并评估通过有针对性的出院处方审查所达到的干预率。
这是一项为期 12 周的单中心回顾性研究，从 2018 年 2 月 19 日至 2018 年 5 月 14 日，实施了一项新的药师驱动的临床服务。处方审查标准是由 EMP 内部审核后确定的，包括评估既定的高警示药物。符合纳入标准的出院处方被过滤到 EHR 的实时工作队列中，以供 EMP 审查。必要时，EMP 与处方医生讨论建议，或根据机构药剂师的权限调整处方。审查干预措施并进行分类，以评估干预率和确定的药物相关问题 (MRP) 类型。
EMP 共审查了 378 份出院处方，共有 158 份处方被确定至少有一种 MRP。其中，70 张处方被干预，从而导致 18.5%的干预率。最常见的干预措施包括改变药物的剂量/频率、药物的持续时间/配药、以及患者教育。干预最多的药物是抗凝剂和抗感染药物。
利用实时通知系统对前瞻性 ED 出院处方进行审查是可行的。使用有针对性的审查标准，药剂师对审查的处方中的 18.5%进行了干预。使用电子病历中的实时通知系统对 EMP 进行前瞻性出院处方审查，为药剂师确保安全和优化处方提供了机会。
