Department of Pharmacy, Hospices Civils de Lyon, Lyon, France
EA 4129 Parcours Santé Systémique, Université Claude Bernard Lyon 1, Villeurbanne, Auvergne-Rhône-Alpes, France.
Eur J Hosp Pharm. 2023 Sep;30(5):273-278. doi: 10.1136/ejhpharm-2021-002786. Epub 2021 Oct 14.
Medication reconciliation is time-consuming and its complete deployment can be difficult. The implementation of a simplified process, such as patient interviews at admission without full reconciliation, may contribute to improve patient care. The objective of the present study was to describe the feasibility and assess the potential effectiveness of implementing pharmacist-led interviews at patient admission to a rheumatology department.
This is a prospective observational study of pharmacist-led interviews at patient admission conducted between April 2015 and May 2017 in the 34-bed rheumatology department of Edouard Herriot Hospital, a French university hospital. These interviews were structured to explore patient medication management at home. The main outcome was the number of medication errors at admission. Other outcomes were the total number of interviews, the number of interviews with at least one new item of information provided by the patient, the number of interviews with at least one medication error detected, and the number of interviews leading to a modification of the hospital medication order.
A total of 247 interviews were carried out; there was an increase in the number of interviews over the study period (n=54 in 2015, n=98 in 2016, and n=95 for the first 5 months of 2017). Among the interviews conducted, 135 (55%) provided new information concerning patient medication management and 117 medication errors were identified in hospital orders (0.47/patient). There were 76 interviews (31%) with at least one medication error; all led to a medication order modification.
The study found that pharmacist-led interviews at patient admission were effective in detecting medication errors. They could be an alternative to a full medication reconciliation process in targeted situations. When the patient interview does not provide sufficiently robust information, full medication reconciliation may be performed.
药物重整既耗时又难以全面实施。简化流程的实施，如在未完全重整的情况下于入院时进行患者访谈，可能有助于改善患者的护理。本研究的目的是描述在风湿科实施药剂师主导的入院患者访谈的可行性，并评估其潜在效果。
这是一项前瞻性观察研究，在 2015 年 4 月至 2017 年 5 月期间，在法国大学医院爱德华·赫里奥特医院的 34 床风湿科进行了由药剂师主导的入院患者访谈。这些访谈旨在探讨患者在家中的药物管理情况。主要结局是入院时的药物错误数量。其他结局是访谈总数、至少有一项患者提供的新信息的访谈数量、至少发现一项药物错误的访谈数量，以及导致修改医院药物医嘱的访谈数量。
共进行了 247 次访谈；研究期间访谈次数有所增加（2015 年为 54 次，2016 年为 98 次，2017 年前 5 个月为 95 次）。在进行的访谈中，有 135 次（55%）提供了有关患者药物管理的新信息，在医院医嘱中发现了 117 个药物错误（0.47/患者）。有 76 次（31%）访谈至少发现一个药物错误；所有访谈都导致了药物医嘱的修改。
研究发现，在患者入院时由药剂师主导的访谈能够有效地发现药物错误。在某些情况下，它们可以替代全面的药物重整过程。当患者访谈提供的信息不够充分时，可以进行全面的药物重整。
