Impact of collaborative pharmaceutical care on older inpatients' medication safety: multicentre stepped-wedge cluster randomised trial (MEDREV Study).

IF 3.8 2区 医学 Q2 GERIATRICS & GERONTOLOGY
Géraldine Leguelinel-Blache, Sophie Bouvet, Pierrick Bedouch, Bérengère Bachelet, Catherine Chenailler, Thomas Dantin, Laure Geneletti, Alexia Janes, Florence Scher, Bogdan Cireașă, Jean-Marie Kinowski, Christel Castelli, Clarisse Roux-Marson
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引用次数: 0

Abstract

Background: Improving medication safety implies patient-centred multidisciplinary cooperation. During the hospital stay for an acute care episode, the patient needs a comprehensive management to guarantee the best possible outcome.

Methods: The study was designed as a non-blinded, multicentre stepped-wedge cluster randomised clinical trial, taking place in six French University Hospitals. Each cluster began with the control period in which standard care did not include pharmaceutical intervention. Every 14-day period, one hospital unit was electronically randomised to switch to the intervention period until all cluster groups received the intervention, which consisted of collaborative pharmaceutical care (CPC) associating medication reconciliation at hospital admission, pharmaceutical analysis of the medication order, medication review and collaborative meeting. The primary outcome was assessing the intervention through the rate of patients with at least one medication error (ME) on the admission medication order (such as omission, wrong dose or wrong route of administration), comparing the two periods.

Results: CPC decreased the rate of patients with at least one ME from 88.9% (n = 243) to 29.2% (n = 267) (p < 0.0001). A total of 1817 MEs were discovered, of which 1121 (61.7%) were in the control period and 696 (38.3%) in the intervention period before resolution by the CPC. After resolving 567 of them, 129 medication errors still remained after CPC. So, a median of 3 MEs [IQR = 1;6] per patient were detected in the control period vs 0 [IQR = 0;1] after CPC in the intervention period (p < 0.0001). Patients were 21-times more likely to avoid a ME with CPC (OR: 20.8 [8.3;52.2], p < 0.0001). The rate of patients with a 2-3 critical ME level decreased from 70.8% to 12.0% in the control vs intervention periods respectively (OR: 18.4 [7.7;43.9], p < 0.0001).

Conclusions: CPC can prevent the occurrence of MEs and thus can improve inpatients' medication management and safety. Pharmacists play a key role in combating medication-related harm in healthcare settings.

Trial registration: This study is registered on ClinicalTrials.gov with the reference number NCT02598115 (2015-11-04).

协同药学服务对老年住院患者用药安全的影响:多中心楔形步聚随机试验(MEDREV研究)。
背景:提高用药安全需要以患者为中心的多学科合作。在住院期间的急性护理事件,病人需要一个全面的管理,以保证最好的可能的结果。方法:该研究被设计为一项非盲法、多中心楔步聚类随机临床试验,在6所法国大学医院进行。每组从标准治疗不包括药物干预的对照期开始。每隔14天,通过电子随机方式将一个医院单元切换到干预期,直到所有群集组都接受干预,干预包括住院时协同药学服务(CPC)相关的药物调节、药物分析、药物审查和协作会议。主要观察指标是通过患者在入院用药单上至少出现一次用药错误(如遗漏、错误剂量或错误给药途径)的比例来评估干预效果,并比较两期的差异。结果:CPC使至少有一种ME的患者比例从88.9% (n = 243)降至29.2% (n = 267) (p)。结论:CPC可以预防ME的发生,从而改善住院患者的用药管理和安全性。药剂师在医疗保健环境中与药物相关的危害作斗争方面发挥着关键作用。试验注册:本研究已在ClinicalTrials.gov上注册,参考号NCT02598115(2015-11-04)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Geriatrics
BMC Geriatrics GERIATRICS & GERONTOLOGY-
CiteScore
5.70
自引率
7.30%
发文量
873
审稿时长
20 weeks
期刊介绍: BMC Geriatrics is an open access journal publishing original peer-reviewed research articles in all aspects of the health and healthcare of older people, including the effects of healthcare systems and policies. The journal also welcomes research focused on the aging process, including cellular, genetic, and physiological processes and cognitive modifications.
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