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经鼻饲管进食患者入院及出院时的多重用药和高警示药物:多中心横断面研究

Polypharmacy and high-alert medications in patients with nasally placed feeding tube on admission and at hospital discharge: Multicenter cross-sectional study.

作者信息

Gimenes Fernanda Raphael Escobar, Freitas Juliana Santana de, Koepp Janine, Prado Patrícia Rezende do, Menezes Rochele Mosmann, Leclerc Jacinthe, Medeiros Adriane Pinto de, Teixeira Thalyta Cardoso Alux, Carvalho Rhanna Emanuela Fontenele Lima de, Zanetti Maria Olívia Barboza, Miasso Adriana Inocenti, Gonella Jennifer Midiani

机构信息

Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil.

Hospital Israelita Albert Einstein, São Paulo, Brazil.

出版信息

Explor Res Clin Soc Pharm. 2024 Jul 4;15:100474. doi: 10.1016/j.rcsop.2024.100474. eCollection 2024 Sep.

Abstract

BACKGROUND

Polypharmacy and the use of high-alert medications in patients with nasally placed feeding tube (NPFT) increase the risks of drug related problems.

OBJECTIVE

Characterize drugs prescribed to patients with NPFT and compare the rates of polypharmacy and high-alert medication use at admission and hospital discharge.

DESIGN AND SETTING

Multicenter cross-sectional study with 327 participants.

METHODS

Data of patients with NPFT were obtained from the medical records and recorded in an electronic data collection tool. Mean number of drugs, polypharmacy and number of high-alert medications prescribed on admission and at discharge were compared using Wilcoxon or McNemar's tests. Generalized Estimating Equations analyzed the relationship between polypharmacy and high-alert medications according to age and time point. Primary reason for hospital admission, level of consciousness, severity of comorbid diseases and patient care complexity were also assessed.

RESULTS

Most patients were male, older people, hospitalized for circulatory system diseases and had at least one comorbidity. On admission, a significant number of patients were alert (59.9%), at high risk for death (43.1%) and high dependent on nursing care (35.4%). Additionally, 92% patients were on polypharmacy on admission, versus 84.7% at hospital discharge ( = 0,0011). The occurrence of polypharmacy was independent of age ( = 0.2377). >17% of all drugs prescribed were high-alert medications, with no statistically significant difference between admission and discharge (p = 0,3957). There was no statistical evidence that the use of high-alert medications increases with age ( = 0,5426).

CONCLUSIONS

These results support the planning of multidisciplinary qualified actions for patients using NPFT.

摘要

背景

鼻饲管(NPFT)患者的多重用药及高警示药物的使用增加了药物相关问题的风险。

目的

描述NPFT患者所开具的药物,并比较入院时和出院时的多重用药率及高警示药物使用率。

设计与地点

一项有327名参与者的多中心横断面研究。

方法

从病历中获取NPFT患者的数据,并记录在电子数据收集工具中。使用Wilcoxon检验或McNemar检验比较入院时和出院时开具的药物平均数量、多重用药情况及高警示药物数量。广义估计方程根据年龄和时间点分析多重用药与高警示药物之间的关系。还评估了入院的主要原因、意识水平、合并症严重程度及患者护理复杂性。

结果

大多数患者为男性、老年人,因循环系统疾病住院,且至少有一种合并症。入院时,相当数量的患者意识清醒(59.9%)、死亡风险高(43.1%)且高度依赖护理(35.4%)。此外,92%的患者入院时存在多重用药情况,而出院时为84.7%(P = 0.0011)。多重用药的发生与年龄无关(P = 0.2377)。所有开具药物中>17%为高警示药物,入院时和出院时无统计学显著差异(P = 0.3957)。没有统计证据表明高警示药物的使用随年龄增加(P = 0.5426)。

结论

这些结果支持为使用NPFT的患者规划多学科的专业措施。

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