PDF(Pubmed)
Abstract：
OBJECTIVE: In many countries, outpatient and inpatient care are separated. During hospitalization, therefore, switching the outpatient medication to medication of the hospital formulary is required.
METHODS: We newly designed a switching algorithm in six switching steps (S0-S5) and conducted a study at Bundeswehr Hospital Hamburg (300 beds, 80% civilians). We performed (i) a medication reconciliation to obtain information on outpatient medications and (ii) a medication review to solve drug-related-problems, e.g., drug-drug interactions. We applied (iii) the algorithm to switch medications to the hospital formulary.
RESULTS: (i) We identified 475 outpatient medications (median per patient: 4; Q25/Q75 2/7) in 100 patients consecutively admitted to hospital (median age: 71; Q25/Q75: 64/80 years). Of 475 medications, the switching algorithm could not be used since product names were missing in 23.9% and strength in 1.7%. In 3.2%, switching was not required since medication was not prescribed during the hospital stay. (ii) Drug-drug interactions were identified in 31 of 79 patients with more than one medication. (iii) Of 475 medications, 18.5% were on the hospital formulary and therefore did not need to be switched (S0), 0.2% were on a substitution-exclusion list not allowing switching (S1), 42.0% were switched to a generic medication of the hospital formulary (S2), 1.7% to a therapeutically equivalent medication (S3), 0.4% were patient-individually switched (S4), and for 8.2% a standardized/patient-individual switching was not possible (S5).
CONCLUSIONS: Despite comprehensive medication reconciliation, patient- and medication-related information for switching medications to the hospital formulary was often missing. Once all the necessary information was available, standardized switching could be easily carried out according to a newly developed switching algorithm.
METHODS: We newly designed a switching algorithm in six switching steps (S0-S5) and conducted a study at Bundeswehr Hospital Hamburg (300 beds, 80% civilians). We performed (i) a medication reconciliation to obtain information on outpatient medications and (ii) a medication review to solve drug-related-problems, e.g., drug-drug interactions. We applied (iii) the algorithm to switch medications to the hospital formulary.
RESULTS: (i) We identified 475 outpatient medications (median per patient: 4; Q25/Q75 2/7) in 100 patients consecutively admitted to hospital (median age: 71; Q25/Q75: 64/80 years). Of 475 medications, the switching algorithm could not be used since product names were missing in 23.9% and strength in 1.7%. In 3.2%, switching was not required since medication was not prescribed during the hospital stay. (ii) Drug-drug interactions were identified in 31 of 79 patients with more than one medication. (iii) Of 475 medications, 18.5% were on the hospital formulary and therefore did not need to be switched (S0), 0.2% were on a substitution-exclusion list not allowing switching (S1), 42.0% were switched to a generic medication of the hospital formulary (S2), 1.7% to a therapeutically equivalent medication (S3), 0.4% were patient-individually switched (S4), and for 8.2% a standardized/patient-individual switching was not possible (S5).
CONCLUSIONS: Despite comprehensive medication reconciliation, patient- and medication-related information for switching medications to the hospital formulary was often missing. Once all the necessary information was available, standardized switching could be easily carried out according to a newly developed switching algorithm.
摘要：
目标：在许多国家，门诊和住院护理是分开的。住院期间,因此,需要将门诊药物转换为医院处方集的药物。
方法：我们在六个切换步骤（S0-S5）中新设计了一种切换算法，并在BundeswehrHamburg医院进行了一项研究（300张病床，80%平民)。我们进行了（i）药物核对以获取有关门诊药物的信息，以及（ii）药物审查以解决与药物相关的问题，例如，药物-药物相互作用。我们应用（iii）该算法将药物转换为医院处方集。
结果：（i）我们确定了连续入院的100例患者（中位年龄：71岁；Q25/Q75：64/80岁）中的475种门诊药物（每位患者中位数：4；Q25/Q752/7）。在475种药物中，无法使用切换算法，因为产品名称缺失了23.9%，强度缺失了1.7%。在3.2%中，由于在住院期间未开药，因此不需要转换。（ii）在79名患者中有31名使用一种以上药物的患者中发现了药物-药物相互作用。在475种药物中，18.5%在医院处方集上，因此不需要切换(S0)，0.2%在不允许切换的替换-排除列表中(S1)，42.0%改用医院处方集(S2)的学名药，1.7%的治疗等效药物（S3），0.4%患者单独切换(S4)，8.2%的患者不可能进行标准化/患者-个体转换(S5).
结论：尽管进行了全面的药物和解，将药物转换为医院处方集的患者和药物相关信息经常缺失.一旦所有必要的信息可用，标准化的切换可以很容易地根据新开发的切换算法进行。
方法：我们在六个切换步骤（S0-S5）中新设计了一种切换算法，并在BundeswehrHamburg医院进行了一项研究（300张病床，80%平民)。我们进行了（i）药物核对以获取有关门诊药物的信息，以及（ii）药物审查以解决与药物相关的问题，例如，药物-药物相互作用。我们应用（iii）该算法将药物转换为医院处方集。
结果：（i）我们确定了连续入院的100例患者（中位年龄：71岁；Q25/Q75：64/80岁）中的475种门诊药物（每位患者中位数：4；Q25/Q752/7）。在475种药物中，无法使用切换算法，因为产品名称缺失了23.9%，强度缺失了1.7%。在3.2%中，由于在住院期间未开药，因此不需要转换。（ii）在79名患者中有31名使用一种以上药物的患者中发现了药物-药物相互作用。在475种药物中，18.5%在医院处方集上，因此不需要切换(S0)，0.2%在不允许切换的替换-排除列表中(S1)，42.0%改用医院处方集(S2)的学名药，1.7%的治疗等效药物（S3），0.4%患者单独切换(S4)，8.2%的患者不可能进行标准化/患者-个体转换(S5).
结论：尽管进行了全面的药物和解，将药物转换为医院处方集的患者和药物相关信息经常缺失.一旦所有必要的信息可用，标准化的切换可以很容易地根据新开发的切换算法进行。
