Zavaleta-Monestel Esteban, Rojas-Barrantes Zoe, Díaz-Madriz José Pablo, Arguedas-Chacón Sebastián, Cordero-García Eugenia, Chaverri-Fernández José
Pharmacy, Hospital Clinica Biblica, San Jose, CRI.
Pharmacy, Hospital Clínica Bíblica, San José, CRI.
Cureus. 2024 Sep 9;16(9):e68998. doi: 10.7759/cureus.68998. eCollection 2024 Sep.
Background The seamless management of transitions of care (TOC) is necessary for patient safety, as it directly correlates with a heightened risk of medication errors and adverse effects. Clinical pharmacists emerge as key stakeholders in optimizing medication management during TOC, specifically during hospital admission and discharge, through the implementation of innovative programs that contribute significantly to the mitigation of medication errors and improve patient satisfaction. Aim This study aims to assess the benefits of pharmacist-led interventions in a Costa Rican private hospital's TOC program for polymedicated and high-risk patients during admission and discharge by identifying and addressing medication errors. Methods A cross-sectional observational study was conducted at Clínica Biblica Hospital in San José, Costa Rica, from February 2022 to May 2023 and focused on polymedicated patients with chronic therapy and high-risk medications. The TOC Medication Program was specifically implemented to focus on medication reconciliation during the admission and discharge processes. A clinical pharmacist documented interventions based on discrepancies found within each patient's medication and assessed the economic impact of interventions on healthcare personnel during discharge by projecting potential complications in the absence of such interventions, a process that was validated by an internist physician. Results During the medication reconciliation at admission, medication discrepancies, mostly intentional omissions, were successfully addressed by clinical pharmacist interventions with a 90.2% acceptance rate during the admission process. At discharge, 18.9% of medications were high-risk, and nearly 40% of discharges were linked to drug-related problems (DRPs), prompting pharmaceutical interventions. The economic analysis indicated potential savings of $21,010.20 during discharge, demonstrating the substantial impact of interventions in preventing emergency service visits, specialist consults, and hospital admissions. Conclusion Pharmacist-led TOC programs offer important clinical advantages by effectively preventing and rectifying medication discrepancies. These discrepancies, if left unaddressed, pose a potential threat to patient safety. Moreover, the implementation of such programs demonstrates promising economic benefits.
背景 无缝的照护过渡(TOC)管理对于患者安全至关重要,因为它与用药错误和不良反应风险的增加直接相关。临床药师在TOC期间优化用药管理方面成为关键利益相关者,特别是在住院和出院期间,通过实施创新项目,这些项目对减少用药错误和提高患者满意度有显著贡献。目的 本研究旨在通过识别和解决用药错误,评估在哥斯达黎加一家私立医院的TOC项目中,药师主导的干预措施对多药治疗和高危患者在住院和出院期间的益处。方法 2022年2月至2023年5月在哥斯达黎加圣何塞的圣经医院进行了一项横断面观察性研究,重点关注接受慢性治疗和使用高危药物的多药治疗患者。TOC用药项目专门实施,以专注于住院和出院过程中的用药核对。临床药师根据每位患者用药中发现的差异记录干预措施,并通过预测无此类干预时的潜在并发症来评估干预措施对出院时医护人员的经济影响,这一过程得到了内科医生的验证。结果 在入院用药核对期间,临床药师的干预成功解决了用药差异,主要是故意遗漏,在入院过程中的接受率为90.2%。出院时,18.9%的药物为高危药物,近40%的出院与药物相关问题(DRP)有关,促使进行药学干预。经济分析表明,出院期间可能节省21,010.20美元,证明了干预措施在预防急诊就诊、专科会诊和再次住院方面的重大影响。结论 药师主导的TOC项目通过有效预防和纠正用药差异提供了重要的临床优势。这些差异若不解决,会对患者安全构成潜在威胁。此外,实施此类项目显示出可观的经济效益。