在医院入院时获取尽可能完善的用药史：一项由药房技术员推动的识别用药差异项目的描述。

Obtaining the Best Possible Medication History at Hospital Admission: Description of a Pharmacy Technician-Driven Program to Identify Medication Discrepancies.

作者信息

Kabir Rubiya, Liaw Samantha, Cerise Jane, Yi Jungen, Mulvany Colm, Qiu Michael, Beizer Judith L, Sinvani Liron D

机构信息

Department of Pharmacy, 24945North Shore University Hospital-Northwell Health, Manhasset, NY, USA.

Feinstein Institute for Medical Research-Biostatistics Unit, 24945North Shore University Hospital-Northwell Health, Manhasset, NY, USA.

出版信息

J Pharm Pract. 2023 Feb;36(1):19-26. doi: 10.1177/08971900211021254. Epub 2021 Jun 3.

DOI:10.1177/08971900211021254

PMID:34080461

Abstract

PURPOSE

Describe the process of obtaining the best possible medication history (BPMH) by Certified Pharmacy Technicians (CPhTs) on hospital admission to identify medication discrepancies.

METHODS

Cross-sectional, descriptive study conducted between December 2016 and June 2017 at a quaternary center in New York, including all patients 18 years and older admitted to the medicine service through the Emergency Department (ED) and seen by a CPhT. CPhTs obtained the BPMH using a systematic approach involving a standardized interview, checking medications with secondary sources and updating the electronic health record (EHR). Medication discrepancies were identified and categorized by type and risk. Summary statistics were provided as average and standard deviation (SD) for continuous variables, and as frequencies and percentages for categorical variables. Multivariable regression was used to test for associations between patient factors and presence of a medication discrepancy.

RESULTS

Of the 3,087 patient visits, the average age was 69 (SD 17.8), 54% were female (n = 1652) and 65% white (n = 2017); comorbidity score breakdown was: 0 (25%, n = 757), 1-2 (33%, n = 1023), 3-4 (23%, n = 699), > 4 (20%, n = 608). The average number of home and discharge medications were 10 (SD 6.1) and 10 (SD 5.4), respectively. The average time spent obtaining the BPMH was 30.6 minutes (SD 12.9). 69% of patients (n = 2130) had at least 1 discrepancy with an average of 4.2 (SD 4.6), of which 43% (n = 920) included high-risk medications. Having a medication discrepancy was associated with a higher number of home medications (p < 0.0001) comorbidities (p < 0.0001), and source of information (p < 0.04).

CONCLUSION

Obtaining the BPMH by CPhTs on hospital admission frequently identifies medication discrepancies. Further studies are needed to evaluate the association between obtaining the BPMH and clinical outcomes.

摘要

目的

描述认证药剂师（CPhTs）在患者入院时获取最佳用药史（BPMH）以识别用药差异的过程。

方法

2016年12月至2017年6月在纽约一家四级医疗中心进行的横断面描述性研究，纳入所有18岁及以上通过急诊科（ED）入院并由CPhT诊治的内科患者。CPhTs采用系统方法获取BPMH，包括标准化访谈、与二级来源核对用药情况以及更新电子健康记录（EHR）。识别用药差异并按类型和风险进行分类。连续变量的汇总统计数据以平均值和标准差（SD）表示，分类变量以频率和百分比表示。使用多变量回归检验患者因素与用药差异存在之间的关联。

结果

在3087次患者就诊中，平均年龄为69岁（SD 17.8），54%为女性（n = 1652），65%为白人（n = 2017）；合并症评分分类为：0（25%，n = 757），1 - 2（33%，n = 1023），3 - 4（23%，n = 699），> 4（20%，n = 608）。家庭用药和出院用药的平均数量分别为10种（SD 6.1）和10种（SD 5.4）。获取BPMH的平均时间为30.6分钟（SD 12.9）。69%的患者（n = 2130）至少存在1处差异，平均差异数为4.2（SD 4.6），其中43%（n = 920）涉及高风险药物。存在用药差异与更多的家庭用药数量（p < 0.0001）、合并症（p < 0.0001）以及信息来源（p < 0.04）相关。