School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia.
Emerg Med J. 2023 Feb;40(2):120-127. doi: 10.1136/emermed-2021-211660. Epub 2022 Aug 1.
Pharmacists have an increasing role as part of the emergency department (ED) team. However, the impact of ED-based pharmacy interventions on the quality use of medicines has not been well characterised.
This systematic review aimed to synthesise evidence from studies examining the impact of interventions provided by pharmacists on the quality use of medicines in adults presenting to ED.
A systematic literature search was conducted in MEDLINE, EMBASE and CINAHL. Two independent reviewers screened titles/abstracts and reviewed full texts. Studies that compared the impact of interventions provided by pharmacists with usual care in ED and reported medication-related primary outcomes were included. Cochrane Risk of Bias-2 and Newcastle-Ottawa tools were used to assess the risk of bias. Summary estimates were pooled using random-effects meta-analysis, along with sensitivity and sub-group analyses.
Thirty-one studies involving 13 242 participants were included. Pharmacists were predominantly involved in comprehensive medication review, advanced pharmacotherapy assessment, staff and patient education, identification of medication discrepancies and drug-related problems, medication prescribing and co-prescribing, and medication preparation and administration. The activities reduced the number of medication errors by a mean of 0.33 per patient (95% CI -0.42 to -0.23, I=51%) and the proportion of patients with at least one error by 73% (risk ratio (RR)=0.27, 95% CI 0.19 to 0.40, I=85.3%). The interventions were also associated with more complete and accurate medication histories, increased appropriateness of prescribed medications by 58% (RR=1.58, 95% CI 1.21 to 2.06, I=95%) and quicker initiation of time-critical medications.
The evidence indicates improved quality use of medicines when pharmacists are included in ED care teams.
CRD42020165234.
药剂师在急诊科（ED）团队中扮演着越来越重要的角色。然而，ED 基础药学干预对药物合理使用的影响尚未得到充分描述。
本系统评价旨在综合评估药师在 ED 提供干预措施对成人患者药物合理使用的影响。
在 MEDLINE、EMBASE 和 CINAHL 中进行系统文献检索。两名独立评审员筛选标题/摘要并审查全文。纳入了比较药师干预与 ED 常规护理对药物相关主要结局影响的研究。使用 Cochrane 偏倚风险-2 工具和纽卡斯尔-渥太华量表评估偏倚风险。使用随机效应荟萃分析汇总汇总估计值，并进行敏感性和亚组分析。
纳入了 31 项研究，涉及 13242 名参与者。药师主要参与全面药物审查、高级药物治疗评估、员工和患者教育、识别药物差异和药物相关问题、药物处方和共处方、药物准备和管理。这些活动使每位患者的药物错误数量平均减少 0.33（95%置信区间-0.42 至-0.23，I=51%），至少有一次错误的患者比例降低了 73%（风险比（RR）=0.27，95%置信区间 0.19 至 0.40，I=85.3%）。干预措施还与更完整和准确的药物史相关，使处方药物的适当性增加 58%（RR=1.58，95%置信区间 1.21 至 2.06，I=95%），并更快地开始使用时间关键药物。
证据表明，当药剂师加入 ED 护理团队时，药物的合理使用质量得到提高。
CRD42020165234。
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