The implementation of pharmacist driven medication reconciliation program at the admission to hospital

Year 2014, Volume: 4 Issue: 4, 226 - 231, 03.05.2015

Mesut Sancar , Pınar Demir Özker Emine Er Bedile Turan Betul Okuyan

Abstract

Objective: The aim of the study was to evaluate pharmacist driven medication reconciliation program at the admission to hospital. 

Method: This study was conducted between February 13, 2012 and April 29, 2012 (two days in a week) at internal medicine and oncology service of a private hospital located in Istanbul, Turkey. Patients were eligible if they were older than 18 years old and if the medication reconciliation form was compiled within 48 hours of admission. The pharmacists reviewed if there were any discrepancies between a patient’s home medication and medications prescribed on admission to the hospital. When the discrepancies were found, the pharmacists investigated further whether if this discrepancy was intentional or unintentional by communicating with patient, patient caregiver, the physician or by checking patient’s pharmacy record. Potentially high-risk admission discrepancies were also identified. The discrepancies were classified as omission, duplication, and name/dose/route confusion. 

Results: Fifty four patients (mean age, 61.07±15.21 years; 26 female / 28 male) were included in the study. Twenty three patients were older than 65 years The overall rate of recently started medications at admission to hospital was 6.4 per patient. Forty seven patients utilized at least one high-risk medication. In admission to hospital, at least one medication was intentionally or unintentionally discontinued in 35 patients. In medication reconciliation process, the total of 23 unintended discrepancies were determined among 12 patients. The overall rate of unintended discrepancies was 0.43 per patient. The most common unintended discrepancies were name/dose/route confusion (n=12) and omission of regularly used medication (n=9). 91.70% of the patients with unintended discrepancy utilized at least one high-risk medication. 

Conclusion: This study showed that the pharmacist driven medication reconciliation program would provide benefit on decreasing medication related problems during admission to hospital and needs to be implemented.

Keywords

Medical reconciliation, clinical pharmacy, admission to hospital

Hastane yatışında eczacı tarafından yürütülen ilaç mutabakatı programının değerlendirilmesi

Abstract

Amaç: Çalışmanın amacı yatan hastalarda eczacı tarafından yürütülen ilaç mutabakatı programının değerlendirilmesiydi. 

Yöntem: Bu çalışma 13 Şubat 2012 ile 29 Nisan 2012 tarihleri arasında (haftada 2 gün olarak) İstanbul’daki özel bir hastanenin dahiliye ve onkoloji servislerinde yürütüldü. Çalışmaya 18 yaşından büyük ve hastaneye yatıştan sonraki 48 saat içinde ilaç mutabakatı formu doldurulan hastalar dahil edildi. Hastanın evde kullandığı ilaçları ile hastaneye yatışında reçete edilen ilaçlar arasındaki farklılıkları eczacılar tarafından gözden geçirildi. Bulunan farklılıkların kasıtlı ve/veya kasıtsız olup olmadığı eczacılar tarafından hasta, refakatçisi ve doktoru ile iletişim kurularak veya hastanın eczane kayıtlarından araştırıldı. Hastane yatışında saptanan ilaç farklılıklarının, potansiyel yüksek riskli ilaçları kapsayıp kapsamadığı da değerlendirildi. Farklılıklar ilaç atlanması, doz tekrarı ve ilaç ismi/dozu/yolu karışıklığı şeklinde sınıflandırıldı.

Bulgular: Çalışmada 54 hasta (ortalama yaş 61.07±15.21; 26 kadın / 28 erkek) değerlendirildi. Hastaların 23’ü 65 yaş ve üzeriydi. Hastane yatışında hastaya yeni başlanan ilaçların oranı hasta başına 6.4 idi. Hastaların 47’sinde en az bir yüksek riskli ilaç kullanımı saptandı. Hastaneye yatışta 35 hastanın en az bir ilacının kasıtlı ya da kasıtsız eksik bildirildiği gözlendi. İlaç mutabakatı sürecinde 12 hastaya ait toplamda 23 kasıtsız farklılık bulundu. Kasıtsız farklılık oranı hasta başına 0.43 idi. En sık rastlanılan kasıtsız farklılıkların ilaç ismi/dozu/yolu karışıklıkları (n=12) ve düzenli kullanılan ilaçların atlanması (n=9) olduğu görüldü. Kasıtsız farklılıklar gözlenen hastaların %91.70’si en az bir yüksek riskli ilaç kullanıyordu. 

Sonuç: Bu çalışma hastaneye yatış sırasında eczacı tarafından yürütülen ilaç mutabakatı programının yaygınlaşması gerektiğini ve hastaneye yatışta karşılaşılan ilaç kaynaklı problemlerin azaltılmasında faydalı olabileceğini göstermiştir.

Keywords

İlaç mutabakatı, klinik eczacılık, hastane yatışı

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