Principal Pharmacist Supply Services, Royal Cornwall Hospitals NHS Trust, Truro, , TR1 3LJ, Cornwall, UK.
Principal Pharmacist Prescribing Support Unit, Royal Cornwall Hospitals NHS Trust, Truro, , TR1 3LJ, Cornwall, UK.
Int J Clin Pharm. 2022 Feb;44(1):27-33. doi: 10.1007/s11096-021-01300-8. Epub 2021 Jul 5.
Background Medication errors can occur because of incomplete or poorly communicated information at the transition from hospital to community. Following an audit in 2016, a project was undertaken to determine if pharmacists could improve the quality of medication information in discharge summaries by introducing a discharge medication reconciliation process. Pharmacists recorded any changes to the patient's medication in the electronic prescribing system during their inpatient stay and summarised these changes on discharge. Objective To compare medication information in discharge summaries with recognised standards for the clinical structure and content of patient records, and to assess the impact of the pharmacist process on compliance with certain elements of these standards. Setting A 750 bed teaching district general hospital in England. Method A retrospective observational study examining all patient discharge summaries over a 1 week period for compliance to national standards. Main outcome measure The main outcome measures were compliance with standards for medication started, stopped or changed in hospital and any differences between extent of recording this information by doctors and pharmacists. Results Data were collected and analysed for 243 patients, of whom 94 (38.7%) attracted a discharge medicines reconciliation process by a pharmacist. Discharge summaries were compliant with basic standards for changed medication in 42% of patients or 51.4% with the input of a pharmacist. This increase of 9.4% was statistically significant (p = 0.0365). At an enhanced level, pharmacists increased compliance from 39.1 to 46.5%, this did not represent a significant increase (p = 0.0989). Conclusion Pharmacists undertaking a discharge medication reconciliation process significantly improves the quality of discharge summaries.
由于医院到社区过渡时信息不完整或沟通不畅，可能会发生用药错误。在 2016 年进行审计后，开展了一个项目，以确定药剂师是否可以通过引入出院药物重整流程来提高出院小结中药物信息的质量。药剂师在住院期间记录患者药物的任何变化，并在出院时总结这些变化。目的：比较出院小结中的药物信息与患者记录的临床结构和内容的公认标准，并评估药剂师流程对符合这些标准某些要素的影响。地点：英国一家拥有 750 张病床的教学区综合医院。方法：回顾性观察性研究，检查一周内所有患者出院小结以符合国家标准。主要结果测量指标：符合在医院开始、停止或更改药物的标准，以及医生和药剂师记录此信息的程度之间的任何差异。结果：共收集和分析了 243 名患者的数据，其中 94 名（38.7%）患者的出院药物重整流程由药剂师执行。在接受药剂师输入的情况下，42%的患者或 51.4%的患者出院小结符合更改药物的基本标准。这增加了 9.4%，具有统计学意义（p=0.0365）。在更高的水平上，药剂师将遵守率从 39.1%提高到 46.5%，但这并没有显著增加（p=0.0989）。结论：药剂师进行出院药物重整流程可显著提高出院小结的质量。
