背景:药房主导的用药史收集和核对已证明用药错误减少,增加患者安全,并提高了成本节约。然而,文献缺乏在术前空间实施此类服务的记录努力,在复杂的手术和高术后入院率之后,拥有准确的药物清单至关重要。
目的:本研究的目的是描述电话药学专业学生和药剂师主导的术前用药和解计划的实施。
方法:这项服务是由3年级和4年级的药学专业学生为泌尿外科肿瘤患者提供电话用药记录的。每周报告在两周内确定了符合计划程序的合格患者。使用标准化方法进行患者沟通和记录,学生撰写了电话相遇笔记,这些笔记由药剂师受体审查并签署。药剂师还根据学生的发现核对了家庭用药清单。
方法:开发并实施了标准化的术前用药和解程序,并利用第三和第四年的药学学生。在患者手术当天和潜在的术后入院时,手术人员可获得结果注释。
方法:进行回顾性图表审查,以评估药学专业学生在药学主导的术前用药和解计划中收集的成功记录的用药史。
结果:在2021年8月至2022年2月之间确定了46份药物和解说明,其中39份符合纳入标准。在177种药物中,删除,和编辑,删除是最常见的,95%的患者至少有一项用药差异.确定的差异代表了总共33个药物类别,每次相遇平均需要33分钟才能完成。
结论:术前药物和解服务可以通过电话药学专业学生和药剂师主导的工作流程成功完成。准确的用药历史有助于最大程度地减少用药错误并提高患者安全性。
BACKGROUND: Pharmacy-led medication history collection and reconciliation have demonstrated decreased medication errors, increased patient safety, and improved cost-savings. However, literature lacks documented efforts to implement such services in the preoperative space, where having accurate medication lists following complex procedures with high postoperative admission rates is critical.
OBJECTIVE: The purpose of this study was to describe the implementation of a telephonic pharmacy student and pharmacist-led preoperative medication reconciliation program.
METHODS: The service was piloted using third- and fourth-year pharmacy students to conduct telephonic medication histories for urologic surgical oncology patients. Weekly reports identified eligible patients with scheduled procedures within 2 weeks\' time. Using standardized methods for patient communication and documentation, students authored telephone encounter notes that were reviewed and signed by pharmacist preceptors. Pharmacist preceptors also reconciled home medication lists based on students\' findings.
METHODS: A standardized preoperative medication reconciliation process was developed and implemented utilizing third- and fourth-year pharmacy students. Resulting notes were available for surgical staff on the day of patients\' procedures and upon potential postoperative admission.
METHODS: A retrospective chart review was conducted to evaluate successfully documented medication histories collected by pharmacy students within the pharmacy-led preoperative medication reconciliation program.
RESULTS: Forty-six medication reconciliation notes were identified between August 2021 and February 2022, and 39 met inclusion criteria. Amongst the 177 medication additions, deletions, and edits, deletions were the most common, and 95% of patients had at least 1 medication discrepancy identified. A total of 33 medication classes were represented by the identified discrepancies, and each encounter took an average of 33 minutes to complete.
CONCLUSIONS: Preoperative medication reconciliation services can be successfully accomplished through a telephonic pharmacy student and pharmacist-led workflow. Accurate medication histories aid in minimizing medication errors and increasing patient safety.