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Impact of pharmacy-led medication reconciliation on medication errors during transition in the hospital setting.

机译：药房主导的药物和解对医院环境过渡期间用药错误的影响。

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Objective : To assess if the pharmacy department should be more involved in the medication reconciliation process to assist in the reduction of medication errors that occur during transition of care points in the hospital setting. Methods : This was an observational prospective cohort study at a 531-bed hospital in Pensacola, FL from June 1, 2014 to August 31, 2014. Patients were included in the study if they had health insurance and were taking five or more medications. Patients with congestive heart failure were excluded from the study. Student pharmacists collected and evaluated medication histories obtained from patients’ community pharmacies, and directed patient interviews. Primary care providers were only contacted on an as needed basis. The information collected was presented to the clinical pharmacist, where interventions were made utilizing clinical judgment. Results : During the three month study, 1045 home medications were reviewed by student pharmacist. Of these, 290 discrepancies were discovered (27.8%; p=0.02). The most common medication discrepancy found was dose optimization (45.5%). The remaining discrepancies included: added therapy (27.6%), other (15.2%), and discontinued therapy (11.7%). Pharmacists made 143 interventions based on clinical judgment (49.3%; p=0.04). Conclusion : Involvement of pharmacy personnel during the medication reconciliation process can be an essential component in reducing medical errors. With the addition of the pharmacy department during the admission process, accuracy, cost savings, and patient safety across all phases and transition points of care were achieved.
机译：目的：评估药房是否应更多地参与药物和解流程，以帮助减少医院环境中转诊点期间发生的用药错误。方法：这是一项观察性前瞻性队列研究，于2014年6月1日至2014年8月31日在佛罗里达州彭萨科拉的一家有531张病床的医院进行。如果患者具有健康保险且正在服用五种或以上药物，则纳入研究。充血性心力衰竭患者被排除在研究之外。学生药剂师收集并评估了从患者社区药房获得的用药史，并指导患者访谈。仅根据需要联系初级保健提供者。收集到的信息被提交给临床药剂师，在该药剂师中，将根据临床判断进行干预。结果：在为期三个月的研究中，学生药剂师审查了1045种家庭用药。其中，发现了290个差异（27.8％; p = 0.02）。发现的最常见药物差异是剂量优化（45.5％）。其余差异包括：增加疗法（27.6％），其他疗法（15.2％）和停药疗法（11.7％）。根据临床判断，药剂师进行了143项干预措施（49.3％; p = 0.04）。结论：药房人员在用药和解过程中的参与可能是减少医疗错误的重要组成部分。在入院过程中增加了药房部门，在护理的所有阶段和过渡点实现了准确性，成本节省和患者安全。

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