临床药师的用药核对对患者入院的影响，以减少急诊科的用药差异：一项前瞻性准干预性研究。

The impact of clinical pharmacists' medication reconciliation upon patients' admission to reduce medication discrepancies in the emergency department: a prospective quasi-interventional study.

作者信息

Shaker Heba Othman, Sabry Ahmed Abdel Fattah, Salah Asmaa, Ragab Gilan Mohamed, Sedik Nahla Ahmed, Ali Zahraa, Magdy Doha, Alkafafy Asmaa Mohamed

机构信息

Alexandria Main University Hospital, Alexandria, Egypt.

出版信息

Int J Emerg Med. 2023 Dec 15;16(1):89. doi: 10.1186/s12245-023-00568-z.

DOI:10.1186/s12245-023-00568-z

PMID:38102544

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10725006/

Abstract

BACKGROUND

The role of the clinical pharmacist in medication reconciliation is well established. Upon patients' admission, the reconciliation service mainly focuses on achieving an accurate and full drug history. This will achieve the best treatment plan and reduce medication discrepancies. Upon the recent implementation of clinical pharmacy services in the emergency department at Alexandria Main University Hospital, medication reconciliation was one of the most important duties that needed to be focused on. We hypothesized that clinical pharmacists are able to achieve patients' drug history lists with higher accuracy than emergency physicians.

RESULTS

A total number of 161 patients were included. Age was 58.59 ± (13.78) years, number of comorbidities was 2.39 ± (1.22) and number of home medications was 4.51 ± (2.72). Clinical pharmacists' fulfillment of patients' drug history was significantly more accurate than the emergency physicians (75.16% and 50.3% of the total number of revised patients' profiles respectively). The clinical pharmacists could put a written copy of the accurate patients' drug history list in only 50.93% of the revised patients' profiles. Five hundred eighty-five medication discrepancies were detected which represent an average of 3.63 discrepancies/medication sheet. Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for medication reconciliation and the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index were used to categorize discrepancies. Categories A, B, and C represented (66.5%), while categories D, E, and F represented (33.5%) of the total discrepancies. There was a significant direct relationship between the total number of discrepancies and both the number of comorbidities and the number of drugs administered before hospital admission.

CONCLUSION

The clinical pharmacists are the main members of the emergency health care team. One of their fundamental services is medication reconciliation. The establishment of a complete drug history list and physicians' discussion about the current treatment plan can obviously detect and reduce medication errors.

TRIAL REGISTRATION

NCT04395443. Registered 16 May 2020.

摘要

背景

临床药师在用药核对中的作用已得到充分确立。在患者入院时，核对服务主要侧重于获取准确且完整的用药史。这将实现最佳治疗方案并减少用药差异。在亚历山大主大学医院急诊科最近实施临床药学服务后，用药核对是需要重点关注的最重要职责之一。我们假设临床药师能够比急诊医生更准确地获取患者的用药史清单。

结果

共纳入161例患者。年龄为58.59±（13.78）岁，合并症数量为2.39±（1.22），家庭用药数量为4.51±（2.72）。临床药师获取患者用药史的准确性明显高于急诊医生（分别占修订患者资料总数的75.16%和50.3%）。临床药师仅在50.93%的修订患者资料中能提供准确的患者用药史清单书面副本。共检测到585处用药差异，平均每张用药单有3.63处差异。使用用药核对的“过渡与临床交接用药（MATCH）工具包”和国家用药错误报告与预防协调委员会（NCC MERP）指数对差异进行分类。A、B和C类占总差异的（66.5%），而D、E和F类占总差异的（33.5%）。差异总数与合并症数量和入院前用药数量之间存在显著的直接关系。