Medication reconciliation at an academic medical center: Implementation of a comprehensive program from admission to discharge
Medication reconciliation at an academic medical center: Implementation of a comprehensive program from admission to discharge
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DOI：
10.2146/ajhp080552
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发表时间：
2009-12-01
影响因子：
2.7
通讯作者：
Zimmerman, Jill M.
中科院分区：
文献类型：
--
作者：
Murphy, Eileen M.;Oxencis, Carolyn J.;Zimmerman, Jill M.
目的.本文介绍了一个学术医疗中心实施一个全面的药物协调计划，以减少入院和出院药物医嘱的错误。成立了一个多学科小组，以评估当前获取用药史的过程，并为药剂师制定一个新的工作流程，以获取和核对用药史。药剂师接受了关于新工作流程、政策和程序的强化培训。提供了全医院范围的多学科教育，并于2005年11月采用了新的程序。每位入院的住院患者在到达医院后24小时内由药剂师或指定人员（药学专业学生或实习生，随后由药剂师进行验证）进行完整和全面的家庭用药史访谈。使用集成的电子病历（EMR）药物记录工具记录用药史的所有组成部分。2006年秋季开始制定出院药物核对方案。通过EMR创建出院药物核对报告表，以提高出院药物医嘱的准确性。该表格为医生提供了完整、准确的药物信息，并降低了转录错误的风险。最后，制定了出院用药报告，供患者带回家。出院核对过程的分析显示，外科单元的用药错误从90%降至47%（95%置信区间[CI]，42-53%; p = 0.000），内科单元的用药错误从57%降至33%（95%CI，28-38%; p = 0.000）。药房驱动的多学科入院史和药物协调过程减少了学术医疗中心的用药错误。
Purpose. The implementation of a comprehensive medication reconciliation program to reduce errors in admission and discharge medication orders at an academic medical center is described.Summary. A multidisciplinary team was formed to assess the current process of obtaining medication histories and to develop a new workflow for the pharmacist to obtain and reconcile medication histories. Pharmacists received intensive training on the new workflow, policies, and procedures. Hospitalwide multidisciplinary education was provided, and the new process was introduced in November 2005. Every inpatient admitted to the hospital has a complete and comprehensive home medication history interview conducted by a pharmacist or designee (pharmacy student or intern with subsequent verification by a pharmacist) within 24 hours of arrival. All components of the medication history are documented utilizing an integrated electronic medical record (EMR) medication documentation tool. Development of the discharge medication reconciliation program began in fall 2006. A discharge medication reconciliation report form was created through the EMR to improve the accuracy of the discharge medication orders. The form provides physicians with complete, accurate medication information and decreases the risk for transcription errors. Finally, a discharge medication report was developed for patients to take home. Analysis of the discharge reconciliation process revealed that medication errors were reduced from 90% to 47% on the surgical unit (95% confidence interval [CI], 42-53%; p = 0.000) and from 57% to 33% on the medicine unit (95% CI, 28-38%; p = 0.000).Conclusion. A pharmacy-driven multidisciplinary admission history and medication reconciliation process has reduced medication errors in an academic medical center.