The effect of a clinical pharmacist discharge service on medication discrepancies in patients with heart failure
The effect of a clinical pharmacist discharge service on medication discrepancies in patients with heart failure
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DOI：
10.1007/s11096-010-9433-6
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发表时间：
2010-12-01
影响因子：
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通讯作者：
van den Bemt, Patricia M. L. A.
中科院分区：
文献类型：
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作者：
Eggink, Rixt Nynke;Lenderink, Albert W.;van den Bemt, Patricia M. L. A.
目的心力衰竭患者住院时间长，用药频繁。除了药物治疗的有意改变外，住院期间也可能发生无意的改变。本研究的目的是探讨临床药师出院服务对心力衰竭患者用药差异和处方错误的影响。背景：荷兰蒂尔堡的一家综合性教学医院。方法采用随机开放的干预研究方法，将干预组与对照组进行比较。临床药剂师出院服务包括出院药物审查、与心脏病专家沟通处方错误、向患者提供信息、编写出院药物书面概述以及与社区药剂师和全科医生就该药物进行沟通。在出院后6周内，所有患者均按常规安排到门诊就诊，并测量药物差异。主要结果测量主要终点是出院时用药处方错误和出院后用药差异的频率。结果对照组44例，干预组41例。对照组中68%的患者至少有一个差异或处方错误，而干预组为39%（RR 0.57（95%CI 0.37-0.88））。对照组中存在差异或处方错误的药物百分比为14.6%，干预组为6.1%（RR 0.42（95%CI 0.27-0.66））。结论临床药师出院服务可显著降低心力衰竭患者出院后1个月内用药不一致和处方错误的风险。
Objective Heart failure patients are regularly admitted to hospital and frequently use multiple medication. Besides intentional changes in pharmacotherapy, unintentional changes may occur during hospitalisation. The aim of this study was to investigate the effect of a clinical pharmacist discharge service on medication discrepancies and prescription errors in patients with heart failure. Setting A general teaching hospital in Tilburg, the Netherlands. Method An open randomized intervention study was performed comparing an intervention group, with a control group receiving regular care by doctors and nurses. The clinical pharmacist discharge service consisted of review of discharge medication, communicating prescribing errors with the cardiologist, giving patients information, preparation of a written overview of the discharge medication and communication to both the community pharmacist and the general practitioner about this medication. Within 6 weeks after discharge all patients were routinely scheduled to visit the outpatient clinic and medication discrepancies were measured. Main outcome measure The primary endpoint was the frequency of prescription errors in the discharge medication and medication discrepancies after discharge combined. Results Forty-four patients were included in the control group and 41 in the intervention group. Sixty-eight percent of patients in the control group had at least one discrepancy or prescription error against 39% in the intervention group (RR 0.57 (95% CI 0.37-0.88)). The percentage of medications with a discrepancy or prescription error in the control group was 14.6% and in the intervention group it was 6.1% (RR 0.42 (95% CI 0.27-0.66)). Conclusion This clinical pharmacist discharge service significantly reduces the risk of discrepancies and prescription errors in medication of patients with heart failure in the 1st month after discharge.