Greenwood Jessica C, Gutierrez Keah, McDermott Michael
Pharmacy/Neurology, Miami Neuroscience Institute, Miami, USA.
Pharmacy, Nova Southeastern University College of Pharmacy, Fort Lauderdale, USA.
Cureus. 2023 Mar 13;15(3):e36067. doi: 10.7759/cureus.36067. eCollection 2023 Mar.
Objective A multidisciplinary collaboration between the neurosurgical team and the pharmacy was established to conduct a pilot study in which discharged neurosurgical patients from a community hospital would receive medication reconciliation services and counseling by a pharmacy specialist to determine the impact on patient safety, readmission rates, and medication compliance. Methods Pharmacists reviewed discharge medication reconciliations of neurosurgical patients to address any discrepancies with the nurse practitioners or physicians prior to discharge and provided discharge medication counseling to the patient/families at the bedside. The service was provided on weekdays during the eight-hour pharmacist shift in addition to other daily responsibilities. Data were analyzed by type and the total number of pharmacy interventions encountered during the discharge medication reconciliation process, time to complete services, and readmission rates. Lastly, the discharged neurosurgical patients that were not seen by pharmacists during the one-month pilot study were reviewed retrospectively to determine potential interventions. Results A total of 48 neurosurgical patients were discharged during the one-month pilot study; 27 patients received discharge medication reconciliation services and counseling from the pharmacy specialists. Sixty-three pharmacy interventions were accepted with prevention of medication errors/adverse drug reactions (21%, n=21) and addition of missing medication (21%, n=21) being the most common intervention types. The mean time to complete the services was 27 minutes and there was one non-medication-related readmission of the 27 patients seen. Twenty-one neurosurgical patients who were discharged without receiving services were reviewed retrospectively. It was determined that there was a potential for another 64 pharmacy interventions in which clarification of indication (33%, n=21) was the most common intervention type, followed by prevention of medication errors/adverse drug reactions (25%, n=16) and addition of missing medication (22%, n=14). There was a total of one medication-related readmission of the 21 patients not seen by the pharmacist during the pilot study. Conclusion The collaboration of pharmacists in the discharge process benefits neurosurgical patients by reducing the number of discrepancies when transitioning home and provides an additional layer of safety to reduce medication errors and/or prevent adverse events.
目的 建立神经外科团队与药房之间的多学科合作，开展一项试点研究，让社区医院的神经外科出院患者接受药房专家的用药核对服务和咨询，以确定其对患者安全、再入院率和用药依从性的影响。方法 药剂师在出院前审查神经外科患者的出院用药核对情况，以解决与执业护士或医生之间的任何差异，并在床边为患者/家属提供出院用药咨询。除其他日常职责外，该服务在工作日药剂师八小时轮班期间提供。对出院用药核对过程中遇到的药房干预类型和总数、完成服务的时间以及再入院率进行了分析。最后，对在为期一个月的试点研究期间未接受药剂师诊治的神经外科出院患者进行回顾性审查，以确定潜在干预措施。结果 在为期一个月的试点研究期间，共有48例神经外科患者出院；27例患者接受了药房专家的出院用药核对服务和咨询。接受了63次药房干预，其中预防用药错误/药物不良反应（21%，n = 21）和添加遗漏药物（21%，n = 21）是最常见的干预类型。完成服务的平均时间为27分钟，在接受诊治的27例患者中有1例与用药无关的再入院情况。对21例未接受服务而出院的神经外科患者进行了回顾性审查。确定还有64次药房干预的可能性，其中明确用药指征（33%，n = 21）是最常见的干预类型，其次是预防用药错误/药物不良反应（25%，n = 16）和添加遗漏药物（22%，n = 14）。在试点研究期间，药剂师未诊治的21例患者中共有1例与用药相关的再入院情况。结论 药剂师在出院过程中的合作有利于神经外科患者，减少回家过渡期间的差异数量，并提供额外的安全保障，以减少用药错误和/或预防不良事件。
