Evaluating medication discrepancies and harm: a matched cohort study of collaborative pharmacist prescribing in a statewide healthcare system using electronic prescribing.

IF 3.2 4区 医学 Q2 PHARMACOLOGY & PHARMACY
Hana Amer, Sally Marotti, Joshua M Inglis, Imaina Widagdo, Sharon Goldsworthy, Jacinta Johnson, Lisa Kalisch Ellett
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引用次数: 0

Abstract

Introduction: Collaborative pharmacist prescribing models involve pharmacists working with doctors and patients to develop medication plans and prescribe medications. Limited evidence exists on the impact of these models on medication discrepancies in hospitals using electronic prescribing systems (EPS).

Aim: This study aimed to evaluate the impact of collaborative pharmacist prescribing on medication discrepancies and potential patient harm within a statewide healthcare system using EPS.

Method: A multi-site matched cohort study involving 240 patients was conducted. EPS data for 120 patients aged ≥ 18 years who received collaborative pharmacist prescribing was matched 1:1 with 120 patients who received usual care of independent medical prescribing. Matching variables were hospital, clinical unit, sex, age, admission date, triage category and pre-admission medication count. The electronic medical record was reviewed to identify undocumented medication discrepancies, which were defined as any unexplained difference between the pharmacist-led medication history and medications prescribed on admission. The frequency of undocumented discrepancies was calculated. An independent multi-disciplinary clinician panel determined potential harm, using the Harm Associated with Medication Error Classification (HAMEC) tool.

Results: There were fewer undocumented discrepancies per medication prescribed in the collaborative pharmacist prescribing group compared to usual care (RR 0.04, 95% CI 0.03-0.06) and the relative risk of undocumented discrepancies per patient was lower (RR 0.23, 95% CI 0.13-0.39). The expert clinician panel found that undocumented discrepancies rarely posed serious or severe harm in either group (0 undocumented discrepancies with potential to cause serious or severe harm in the collaborative pharmacist prescribing group compared to 8 in the usual care group).

Conclusion: The implementation of collaborative pharmacist prescribing within a statewide EPS significantly reduced undocumented discrepancies and lowered the potential for patient harm. As healthcare systems globally shift towards electronic prescribing, this study provides timely and actionable evidence to inform policy and support the adoption of collaborative prescribing models in hospitals using EPS. Such models offer a practical strategy to improve medication safety, reduce patient harm and strengthen interprofessional collaboration at the point of prescribing.

评估药物差异和危害:在全州医疗保健系统中使用电子处方的协作药剂师处方的匹配队列研究。
导读:协作药剂师处方模式涉及药剂师与医生和患者一起制定药物计划和开药。在使用电子处方系统(EPS)的医院中,这些模型对药物差异的影响证据有限。目的:本研究旨在评估协同药剂师处方对使用EPS的全州医疗保健系统中药物差异和潜在患者伤害的影响。方法:对240例患者进行多地点匹配队列研究。120例年龄≥18岁接受协同药剂师处方的患者EPS数据与120例接受独立医疗处方常规护理的患者EPS数据1:1匹配。匹配变量为医院、临床单位、性别、年龄、入院日期、分诊分类和入院前用药计数。审查了电子病历,以确定无记录的用药差异,其定义为药剂师主导的用药史与入院时处方的药物之间任何无法解释的差异。计算了未记录的差异的频率。一个独立的多学科临床医生小组使用与用药错误相关的危害分类(HAMEC)工具确定潜在危害。结果:与常规护理相比,协作药剂师开处方组的每一种药物的无记录差异较少(RR 0.04, 95% CI 0.03-0.06),每位患者无记录差异的相对风险较低(RR 0.23, 95% CI 0.13-0.39)。专家临床医生小组发现,未记录的差异在两组中都很少造成严重或严重伤害(在协作药剂师处方组中有0个未记录的差异可能造成严重或严重伤害,而在常规护理组中有8个)。结论:在全州EPS内实施协同药剂师处方显著减少了无文件记录的差异,降低了对患者伤害的可能性。随着全球医疗保健系统转向电子处方,本研究提供了及时和可操作的证据,为政策提供信息,并支持医院使用EPS采用协作处方模式。这种模式提供了一种切实可行的策略,以改善用药安全,减少对患者的伤害,并在开处方时加强专业间的合作。
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来源期刊
CiteScore
4.10
自引率
8.30%
发文量
131
审稿时长
4-8 weeks
期刊介绍: The International Journal of Clinical Pharmacy (IJCP) offers a platform for articles on research in Clinical Pharmacy, Pharmaceutical Care and related practice-oriented subjects in the pharmaceutical sciences. IJCP is a bi-monthly, international, peer-reviewed journal that publishes original research data, new ideas and discussions on pharmacotherapy and outcome research, clinical pharmacy, pharmacoepidemiology, pharmacoeconomics, the clinical use of medicines, medical devices and laboratory tests, information on medicines and medical devices information, pharmacy services research, medication management, other clinical aspects of pharmacy. IJCP publishes original Research articles, Review articles , Short research reports, Commentaries, book reviews, and Letters to the Editor. International Journal of Clinical Pharmacy is affiliated with the European Society of Clinical Pharmacy (ESCP). ESCP promotes practice and research in Clinical Pharmacy, especially in Europe. The general aim of the society is to advance education, practice and research in Clinical Pharmacy . Until 2010 the journal was called Pharmacy World & Science.
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