Pharmacist participation on physician rounds and adverse drug events in the intensive care unit
Pharmacist participation on physician rounds and adverse drug events in the intensive care unit
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DOI：
10.1001/jama.282.3.267
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发表时间：
1999-07-21
影响因子：
120.7
通讯作者：
Bates, DW
中科院分区：
文献类型：
--
作者：
Leape, LL;Cullen, DJ;Bates, DW
重症监护病房（ICU）的药剂师审查药物订单已被证明可以防止错误，药剂师咨询降低了药物成本。然而，药剂师在开处方时在ICU的参与是否减少了不良事件还没有研究。目的探讨药师参与ICU查房对医嘱错误引起的可预防药物不良事件发生率的影响。阶段1（基线）和阶段2（实施干预后）的前后对比，以及阶段2与未接受干预的控制单元的对比。设置某大型城市教学医院的内科重症监护室（研究单元）和冠状动脉监护室（控制单元）。从三个组中随机抽取75名患者：1993年2月1日至1993年7月31日（基线）所有入组患者和1994年10月1日至1995年7月7日所有入组患者。此外，在基线期间从对照单元随机选择50例患者。一名高级药剂师与ICU小组进行了查房，并在上午留在ICU进行咨询，全天待命。主要结局指标：可预防的不良事件，由于订购（处方）错误和数量，类型和接受的干预措施的药剂师。通过回顾干预前和干预后阶段随机选择的患者的医疗记录，确定可预防的ade。药剂师记录所有推荐，然后按类型和接受程度进行分析。结果：可预防的ade发生率从干预前的每1000患者日10.4例（95%可信区间[CI]， 7-14）下降到3.5例(95% CI, 1-5， P
Context Pharmacist review of medication orders in the intensive care unit (ICU) has been shown to prevent errors, and pharmacist consultation has reduced drug costs. However, whether pharmacist participation in the ICU at the time of drug prescribing reduces adverse events has not been studied.Objective To measure the effect bf pharmacist participation on medical rounds in the ICU on the rate of preventable adverse drug events (ADEs) caused by ordering errors.Design Before-after comparison between phase 1 (baseline) and phase 2 (after intervention implemented) and phase 2 comparison with a control unit that did not receive the intervention.Setting A medical ICU (study unit) and a coronary care unit (control unit) in a large urban teaching hospital.Patients Seventy-five patients randomly selected from each of 3 groups: all admissions to the study unit from February 1, 1993, through July 31, 1993 (baseline) and all admissions to the study unit (postintervention) and control unit from October 1, 1994, through July 7, 1995. In addition, 50 patients were selected at random from the control unit during the baseline period.Intervention A senior pharmacist made rounds with the ICU team and remained in the ICU for consultation in the morning, and was available on call throughout the day.Main Outcome Measures Preventable ADEs due to ordering (prescribing) errors and the number, type, and acceptance of interventions made by the pharmacist. Preventable ADEs were identified by review of medical records of the randomly selected patients during both preintervention and postintervention phases. Pharmacists recorded all recommendations, which were then analyzed by type and acceptance.Results The rate of preventable ordering ADEs decreased by 66% from 10.4 per 1000 patient-days (95% confidence interval [CI], 7-14) before the intervention to 3.5 (95% CI, 1-5, P