J Am Pharm Assoc (2003). 2024 Jul-Aug;64(4):102100. doi: 10.1016/j.japh.2024.102100. Epub 2024 Apr 16.
Approximately 50% to 70% of patients have at least 1 medication discrepancy in their initial medication history. These discrepancies can lead to errors on admission and discharge orders and have the potential to cause patient harm and incur added costs associated with increased length of stay and readmission rates. Several studies have demonstrated improved medication history accuracy with pharmacy-conducted services, but variations in practice exist due to challenges with workflow and resources.
This study aims to assess the impact of implementing a patient risk-scoring tool for the prioritization of medication history review by pharmacy staff.
This quasi-experimental, single-center study was conducted at a 948-bed academic medical center as a pilot study with the medication history team which consists of pharmacists and certified pharmacy technicians in the emergency department. The endpoints assessed included pharmacy completion rate of patients in the high-risk category, overall pharmacy conducted medication history rate, and the proportion of medication discrepancies identified after reconciliation.
The number of medication histories completed by pharmacy (n=849) decreased by 5.7% in the postintervention period (P = 0.002). Between the preintervention and postintervention period, there were fewer low-risk patients being captured by pharmacy (89.7% to 59.9%, respectively). There was also an increase in the number of medium-risk (Δ=25.4%) and high-risk patients (Δ=4.4%) being captured by pharmacy staff (P < 0.017, α = 0.017).
Use of a risk-scoring tool allowed pharmacy staff to prioritize workflow and capture more high-risk patients for medication history.
约 50%至 70%的患者在初始用药史中至少有 1 种用药差异。这些差异可能导致入院和出院医嘱出现错误，并有可能导致患者受到伤害，增加因住院时间延长和再入院率增加而产生的相关成本。多项研究表明，药房提供的服务可提高用药史的准确性，但由于工作流程和资源方面的挑战，实践中存在差异。
本研究旨在评估实施患者风险评分工具以优先进行药房工作人员进行用药史审查对患者的影响。
这项准实验性、单中心研究在一家 948 床位的学术医疗中心进行，作为一个试点研究，用药史团队由急诊科的药剂师和认证药房技术人员组成。评估的终点包括高危类别的患者药房完成率、整体药房进行用药史的比例，以及经核对后发现的用药差异比例。
在干预后期间，药房完成的用药史数量（n=849）减少了 5.7%（P=0.002）。在干预前和干预后期间，被药房捕捉到的低危患者数量减少（分别为 89.7%至 59.9%）。被药房工作人员捕捉到的中危（Δ=25.4%）和高危（Δ=4.4%）患者数量也有所增加（P<0.017，α=0.017）。
使用风险评分工具使药房工作人员能够优先安排工作流程，为更多的高危患者进行用药史核对。
