使用改良触发工具前瞻性地识别老年住院患者的药物伤害

IF 1 Q4 PHARMACOLOGY & PHARMACY

Journal of Pharmacy Practice and Research Pub Date : 2024-07-26 DOI:10.1002/jppr.1929

Andre Wang, Jonathan Yong Jie Lam, Nazanin Falconer, Michael A Barras

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引用次数: 0

摘要

药物伤害（MH）会导致患者发病，是医疗保健的一大负担。对 MH 的研究日益增多，但识别 MH 的有效方法却存在争议。MH 的发生率往往基于不完整的回顾性病历审查或自发报告，依赖于繁忙的临床医生。我们需要一种实用且与临床相关的方法来检测 MH。我们对一种国际通用的触发工具（TT）进行了同行评估和修改，以便在一家四级医院的老年病房中使用。患者招募为期 6 个月。TT用于前瞻性地帮助识别MH，并对其因果关系和严重程度进行评估。对每种触发因素的阳性预测值（PPV）进行了估算，以确定其在识别 MH 方面的灵敏度。该研究获得了大都会南部人类研究伦理委员会的伦理批准（参考编号：HREC/2022/QMS/80654），并符合澳大利亚国家人类研究伦理行为声明。在对方案设计进行充分解释后，所有参与者通过填写书面同意书获得了知情同意。50 名患者表示同意，其中 16 名（32%）患者经历了一次或多次 MH 事件。共有 257 个触发器被激活（平均每个患者 5.14 个），31 个触发器（12%）预测到了事件的发生。在这 31 起事件中，19 起（61.3%）被评为轻度事件，12 起（38.7%）被评为中度至重度事件。最常见的事件是出血/大面积瘀伤、严重便秘、腹泻和呕吐。PPV最高的触发因素包括触发因素T5（出血/瘀伤）、T9（胃肠功能紊乱）和T11（严重便秘），PPV分别为0.455、0.238和0.286。

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Prospective identification of medication harm in geriatric inpatients using a modified trigger tool

Medication harm (MH) causes patient morbidity and is a major healthcare burden. Research into MH is growing, but effective methods to identify MH are debated. The prevalence of MH is often based on an incomplete, retrospective chart review or spontaneous reporting, reliant on busy clinicians. A practical and clinically relevant method to detect MH is required. A trigger tool (TT) offers a solution.To evaluate a modified TT to prospectively detect MH and determine the prevalence and severity of MH in a geriatric population.An international TT was peer evaluated and modified for use in a geriatric ward of a quaternary hospital. Patients were recruited over a 6‐month period. The TT was applied to prospectively help identify MH, which was assessed for causality and severity. Positive predictive values (PPV) were estimated for each trigger to determine its sensitivity in identifying MH. Ethics approval was granted by the Metro South Human Research Ethics Committee (Reference no: HREC/2022/QMS/80654) and the study conforms to the Australian National Statement on Ethical Conduct in Human Research. Informed consent was obtained from all participants through completion of a written consent form, after a full explanation of the protocol design.Fifty patients consented, of which 16 (32%) patients experienced one or more MH events. A total of 257 triggers were activated (mean of 5.14 per patient) and 31 (12%) predicted an event. Of the 31 events, 19 (61.3%) events were rated as mild and 12 (38.7%) events were rated as moderate to severe. The most common events were bleeding/large bruising, major constipation, diarrhoea, and vomiting. The triggers with the highest PPV included triggers T5 (bleeding/bruising), T9 (gastrointestinal disorders), and T11 (major constipation) with PPVs of 0.455, 0.238, and 0.286, respectively.A modified TT helped to detect MH in a geriatric population and will aid in identifying events in future studies.

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来源期刊

Journal of Pharmacy Practice and Research Health Professions-Pharmacy

CiteScore

1.60

自引率

9.50%

发文量

期刊介绍： The purpose of this document is to describe the structure, function and operations of the Journal of Pharmacy Practice and Research, the official journal of the Society of Hospital Pharmacists of Australia (SHPA). It is owned, published by and copyrighted to SHPA. However, the Journal is to some extent unique within SHPA in that it ‘…has complete editorial freedom in terms of content and is not under the direction of the Society or its Council in such matters…’. This statement, originally based on a Role Statement for the Editor-in-Chief 1993, is also based on the definition of ‘editorial independence’ from the World Association of Medical Editors and adopted by the International Committee of Medical Journal Editors.