Mahomedradja Rashudy F, Lissenberg-Witte Birgit I, Sigaloff Kim C E, Tichelaar Jelle, van Agtmael Michiel A
Amsterdam UMC location Vrije Universiteit Amsterdam, Internal Medicine Pharmacotherapy Unit, Amsterdam, the Netherlands.
Amsterdam UMC location Vrije Universiteit Amsterdam, Research and Expertise Centre in Pharmacotherapy Education, Amsterdam, the Netherlands.
Br J Clin Pharmacol. 2025 Mar;91(3):789-798. doi: 10.1111/bcp.16253. Epub 2024 Oct 17.
Evaluating a patient's medication list is critical to reduce prescribing errors (PEs), but is a labour- and time-intensive process. Identification of patients at risk of PEs could improve the allocation of scarce time and resources, but currently available prediction tools are not effective.
To investigate whether ward doctors can identify patients at risk of PEs.
This prospective matched case-control study was conducted on three clinical wards in an academic hospital. Otolaryngology and oncology ward doctors used clinical intuition to select patients requiring a clinical medication review (CMR) (cases). These patients were then matched 1:1 on age (±10 years) and number (±1) of prescriptions with patients not selected for CMRs on the internal medicine and upper gastrointestinal surgery ward (controls). A multidisciplinary in-hospital pharmacotherapeutic stewardship team assessed the prevalence of PEs.
A total of 387 patients with 5191 prescriptions were included. Overall, 799 PEs affecting 279 patients (72.1%) were identified. Most PEs (58.8%) occurred during hospitalization. There were no significant differences in age, number of prescriptions, sex, renal function or documented allergies or intolerances between the cases and controls or between controls and other patients who did not receive a CMR. The incidence of PEs was higher in cases than in controls (97.5% vs 72.5%, odds ratio = 14.8, 95% confidence interval [CI] 1.8-121.1, P = .002)). The rate of PEs was three times higher in cases than in controls (incidence rate ratio = 3.0, 95% CI 2.3-4.0, P < .001).
Ward doctors can effectively identify patients with PEs, and thus at risk of medication-related harm, using clinical intuition.
评估患者的用药清单对于减少处方错误（PEs）至关重要，但这是一个耗费人力和时间的过程。识别有处方错误风险的患者可以改善稀缺时间和资源的分配，但目前可用的预测工具并不有效。
调查病房医生是否能够识别有处方错误风险的患者。
这项前瞻性配对病例对照研究在一家教学医院的三个临床病房进行。耳鼻喉科和肿瘤科病房医生运用临床直觉选择需要进行临床用药审查（CMR）的患者（病例组）。然后将这些患者与在内科和上消化道外科病房未被选作CMR的患者按年龄（±10岁）和处方数量（±1）进行1:1配对（对照组）。一个多学科的院内药物治疗管理团队评估了处方错误的发生率。
共纳入387例患者，有5191张处方。总体而言，识别出799处影响279例患者（72.1%）的处方错误。大多数处方错误（58.8%）发生在住院期间。病例组和对照组之间，以及对照组和其他未接受CMR的患者之间，在年龄、处方数量、性别、肾功能或记录的过敏或不耐受情况方面均无显著差异。病例组的处方错误发生率高于对照组（97.5%对72.5%，优势比=14.8，95%置信区间[CI]1.8 - 121.1，P = 0.002）。病例组的处方错误率比对照组高3倍（发生率比=3.0，95% CI 2.3 - 4.0，P < 0.001）。
病房医生可以运用临床直觉有效地识别有处方错误的患者，从而识别出有药物相关伤害风险的患者。
