Pharmacist-managed inpatient discharge medication reconciliation: A combined onsite and telepharmacy model
Pharmacist-managed inpatient discharge medication reconciliation: A combined onsite and telepharmacy model
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DOI：
10.2146/ajhp130650
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发表时间：
2014-12-15
影响因子：
2.7
通讯作者：
Vincent, Joan
中科院分区：
文献类型：
--
作者：
Keeys, Christopher;Kalejaiye, Bamidele;Vincent, Joan
目的.描述了由药剂师管理的具有异地远程药房支持的出院药物核对服务的开发、实施和试点测试。医院继续努力在出院前为患者准备清晰、完整和准确的药物清单。由于人员配备和时间限制以及信息技术欠佳，情况变得更加复杂。为了应对这些挑战，一家拥有324张床位的社区医院的药剂科启动了一个质量改进项目，以优化患者的出院药物清单，同时解决经常导致清单混乱、不完整或不准确的问题。医院的药房和治疗委员会的一个小组委员会领导了一个修订的药物核对过程的开发，旨在简化和提高出院药物文件的准确性和实用性，随后实施了一个新的服务模式，包括现场和远程药剂师。在一个为期19个月的试点项目中，对选定的患者护理单位的新流程和服务进行了评估，该项目需要医生、护士、病例管理人员、药剂师和门诊处方药数据库供应商的合作。在试点测试期间，编制了6402份全面核对的出院用药清单;检测到634份记录的差异或用药错误。大多数发现的问题分为三类：未协调的药物订单（31%），订单澄清（25%）和重复订单（12%）。最有问题的药物是阿片类药物、心血管药物和抗凝剂。药剂师管理的药物核对服务，包括现场药剂师和远程药房支持，成功地改善了患者收到的最终出院名单和文件。
Purpose. The development, implementation, and pilot testing of a discharge medication reconciliation service managed by pharmacists with offsite telepharmacy support are described.Summary. Hospitals' efforts to prepare legible, complete, and accurate medication lists to patients prior to discharge continue. to be complicated by staffing and time constraints and suboptimal information technology. To address these challenges, the pharmacy department at a 324-bed community hospital initiated a quality-improvement project to optimize patients' discharge medication lists while addressing problems that often resulted in confusing, incomplete, or inaccurate lists. A subcommittee of the hospital's pharmacy and therapeutics committee led the development of a revised medication reconciliation process designed to streamline and improve the accuracy and utility of discharge medication documents, with subsequent implementation of a new service model encompassing both onsite and remote pharmacists. The new process and service were evaluated on selected patient care units in a 19-month pilot project requiring collaboration by physicians, nurses, case managers, pharmacists, and an outpatient prescription drug database vendor. During the pilot testing period, 6402 comprehensive reconciled discharge medication lists were prepared; 634 documented discrepancies or medication errors were detected. The majority of identified problems were in three categories: unreconciled medication orders (31%), order clarification (25%), and duplicate orders (12%). The most problematic medications were the opioids, cardiovascular agents, and anticoagulants.Conclusion. A pharmacist-managed medication reconciliation service including onsite pharmacists and telepharmacy support was successful in improving the final discharge lists and documentation received by patients.