PDF(Pubmed)
Abstract：
OBJECTIVE: There were three main objectives of the study: to determine the overall compliance of medication reconciliation over 4 years in a tertiary care hospital, to compare the medication reconciliation compliance between paper entry (initial assessment forms) and computerised physician order entry (CPOE), and to identify the discrepancies between the medication history taken by the physician at the time of admission and those collected by the pharmacist within 24 hours of admission.
METHODS: This study was conducted at a tertiary care hospital in a lower middle-income country. Data were gathered from two different sources. The first source involved retrospective data obtained from the Quality and Patient Safety Department (QPSD) of the hospital, consisting of records from 8776 patients between 2018 and 2021. The second data source was also retrospective from a quality project initiated by pharmacists at the hospital. Pharmacists collected data from 1105 patients between 2020 and 2021, specifically focusing on medication history and identifying any discrepancies compared with the history documented by physicians. The collected data were then analysed using SPSS V.26.
RESULTS: The QPSD noted an improvement in physician-led medication reconciliation, with a rise from 32.7% in 2018 to 69.4% in 2021 in CPOE. However, pharmacist-led medication reconciliation identified a 25.4% (n=281/1105) overall discrepancy in the medication history of patients admitted from 2020 to 2021, mainly due to incomplete medication records in the initial assessment forms and CPOE. Physicians missed critical drugs in 4.9% of records; pharmacists identified and updated them.
CONCLUSIONS: In a lower middle-income nation where hiring pharmacists to conduct medication reconciliation would be an additional cost burden for hospitals, encouraging physicians to record medication history more precisely would be a more workable method. However, in situations where cost is not an issue, it is recommended to adopt evidence-based practices, such as integrating clinical pharmacists to lead medication reconciliation, which is the gold standard worldwide.
METHODS: This study was conducted at a tertiary care hospital in a lower middle-income country. Data were gathered from two different sources. The first source involved retrospective data obtained from the Quality and Patient Safety Department (QPSD) of the hospital, consisting of records from 8776 patients between 2018 and 2021. The second data source was also retrospective from a quality project initiated by pharmacists at the hospital. Pharmacists collected data from 1105 patients between 2020 and 2021, specifically focusing on medication history and identifying any discrepancies compared with the history documented by physicians. The collected data were then analysed using SPSS V.26.
RESULTS: The QPSD noted an improvement in physician-led medication reconciliation, with a rise from 32.7% in 2018 to 69.4% in 2021 in CPOE. However, pharmacist-led medication reconciliation identified a 25.4% (n=281/1105) overall discrepancy in the medication history of patients admitted from 2020 to 2021, mainly due to incomplete medication records in the initial assessment forms and CPOE. Physicians missed critical drugs in 4.9% of records; pharmacists identified and updated them.
CONCLUSIONS: In a lower middle-income nation where hiring pharmacists to conduct medication reconciliation would be an additional cost burden for hospitals, encouraging physicians to record medication history more precisely would be a more workable method. However, in situations where cost is not an issue, it is recommended to adopt evidence-based practices, such as integrating clinical pharmacists to lead medication reconciliation, which is the gold standard worldwide.
摘要：
目的：该研究有三个主要目的：确定三级保健医院4年以上药物治疗的总体依从性，比较纸质录入（初始评估表格）和计算机化医嘱录入（CPOE）之间的药物和解依从性，并确定入院时医生的用药史与入院后24小时内药剂师收集的用药史之间的差异。
方法：本研究是在中低收入国家的三级保健医院进行的。数据来自两个不同的来源。第一个来源涉及从医院质量和患者安全部门（QPSD）获得的回顾性数据，包括2018年至2021年8776例患者的记录。第二个数据源也来自医院药剂师发起的质量项目。药剂师收集了2020年至2021年之间1105名患者的数据，特别关注用药史，并确定与医生记录的病史相比的任何差异。然后使用SPSSV.26对收集的数据进行分析。
结果：QPSD注意到医生主导的药物和解有所改善，CPOE从2018年的32.7%上升到2021年的69.4%。然而,药剂师主导的药物核对发现,2020年至2021年期间收治的患者的用药史总体差异为25.4%(n=281/1105),这主要是由于初始评估表格和CPOE中的用药记录不完整.医生在4.9％的记录中遗漏了关键药物；药剂师识别并更新了它们。
结论：在一个中低收入国家，雇用药剂师进行药物和解将给医院带来额外的成本负担，鼓励医生更准确地记录用药史将是一种更可行的方法。然而,在成本不是问题的情况下，建议采用循证实践，如整合临床药师领导药物和解，这是全球的黄金标准。
方法：本研究是在中低收入国家的三级保健医院进行的。数据来自两个不同的来源。第一个来源涉及从医院质量和患者安全部门（QPSD）获得的回顾性数据，包括2018年至2021年8776例患者的记录。第二个数据源也来自医院药剂师发起的质量项目。药剂师收集了2020年至2021年之间1105名患者的数据，特别关注用药史，并确定与医生记录的病史相比的任何差异。然后使用SPSSV.26对收集的数据进行分析。
结果：QPSD注意到医生主导的药物和解有所改善，CPOE从2018年的32.7%上升到2021年的69.4%。然而,药剂师主导的药物核对发现,2020年至2021年期间收治的患者的用药史总体差异为25.4%(n=281/1105),这主要是由于初始评估表格和CPOE中的用药记录不完整.医生在4.9％的记录中遗漏了关键药物；药剂师识别并更新了它们。
结论：在一个中低收入国家，雇用药剂师进行药物和解将给医院带来额外的成本负担，鼓励医生更准确地记录用药史将是一种更可行的方法。然而,在成本不是问题的情况下，建议采用循证实践，如整合临床药师领导药物和解，这是全球的黄金标准。
