Northwest Telepharmacy Solutions Winnipeg, Manitoba, Canada.
Can J Rural Med. 2021 Oct-Dec;26(4):151-159. doi: 10.4103/cjrm.cjrm_74_20.
Medication reconciliation (MedRec) reduces the risk of preventable medication-related adverse events (ADEs). A best possible medication discharge plan (BPMDP) is a revised list of medications a patient will take when discharged from hospital; a pharmacist review ensures accuracy. For many hospitals, on-site pharmacists are non-existent. Extension of a visual presence via a mobile robotic platform with real-time audiovisual communication by pharmacists to conduct MedRec remains unstudied. This study explored patient perceptions of a pharmacist-led BPMDP using a telepresence robot. Time requirements, unintentional discharge medication discrepancies (UMD), programme inefficiencies/barriers and facilitators involved in pharmacist review of the discharge medication list and patient interviews were also described.
This prospective cohort study enrolled adult patients admitted to a 12-bed community hospital at high risk of an ADE. Remote pharmacists reviewed the discharge prescription list, identified/resolved UMDs, and interviewed/counselled patients using a telepresence robot. Thereafter, patients completed an anonymous satisfaction questionnaire. Prescriber discharge UMDs were classified, and barriers/inefficiencies and facilitators were documented.
Nine patients completed an interview, with a 75% interview agreement rate. All patients were comfortable with the robot and 76% felt their care was better. With a median of 11 discharge medications/patient, the UMD rate was 78%; 71% had omitted medications, 43% involved a cardiovascular medication, 88% were due to a hospital system cause, and 43% were specifically due to an inaccurate best possible admission medication history. Median times for interview preparation, interview and UMD/drug therapy problem resolution were 45, 15 and 10 min, respectively.
Using a telepresence robot to provide pharmacist-led BPMDPs is acceptable to patients and an innovative, effective solution to identify/resolve UMDs.
药物重整（MedRec）可降低预防用药相关不良事件（ADE）的风险。最佳可能的出院带药计划（BPMDP）是患者出院后将要服用的药物修订清单；药师审核可确保其准确性。对于许多医院来说，现场药师并不存在。通过药师实时视听通讯的移动机器人平台，扩展虚拟存在，以进行药物重整，这方面的研究尚属空白。本研究探讨了患者对药剂师主导的 BPMDP 使用远程呈现机器人的看法。还描述了药师对出院带药清单进行审核的时间要求、非故意出院用药差异（UMD）、程序效率低下/障碍以及促成因素，以及对患者的访谈。
这项前瞻性队列研究纳入了在高危 ADE 社区医院的 12 张病床住院的成年患者。远程药师使用远程呈现机器人审查出院处方清单，识别/解决 UMD，并对患者进行访谈/咨询。之后，患者完成了匿名满意度问卷。对处方医生出院 UMD 进行分类，并记录障碍/效率低下和促成因素。
9 名患者完成了访谈，访谈一致性率为 75%。所有患者都对机器人感到舒适，76%的患者认为他们的护理更好。每位患者平均有 11 种出院药物，UMD 率为 78%；71%的药物被遗漏，43%涉及心血管药物，88%是由于医院系统原因，43%是由于不准确的最佳入院药物史。访谈准备、访谈和 UMD/药物治疗问题解决的中位数时间分别为 45、15 和 10 分钟。
使用远程呈现机器人提供药剂师主导的 BPMDP 是患者可以接受的，并且是一种创新、有效的解决方案，可用于识别/解决 UMD。
