OBJCETIVE: To investigate the role of clinical pharmacists in medication reconciliation. METHODS: Totally 200 inpatients admitted or transferred to nephrology department of our hospital during Aug.-Oct. 2015 were selected. Within 48 h after admission, 1-year medication history were collected by reviewing electronic medical records, consultation, querying self-prepared drugs and medical history; and then medication reconciliation was conducted by clinical pharmacists. RESULTS: Among drug lists collected by clinical pharmacists, there were 987 kinds of drugs, but only 9.63% (95 kinds) drugs were recorded in the medical records. There were 5 cases of ADR in total, and only 40.00% of them (2 cases) were recorded in the medical records. Among 200 patients, medication reconciliation was needed in 45 cases with reconciliation rate of 22.50%. Among 492 medical orders of 200 patients, medication errors were found in 103 medical orders; the number of medication errors per case was (2.3±1.8), mainly including wrong dose, repeated medication, wrong solvent, drug interactions; the potential risk degree was mainly degree 1(53 orders, 51.46%). Among 103 medication reconciliation orders, main plans were drug withdrawal (78 cases, 75.73%), followed by drug change (17 cases, 16.50%) and drug supplement (8 cases, 7.77%). A total of 90 reconciled medical orders were adopted by physicians, with success rate of 87.38%. CONCLUSIONS: Compared with physicians, clinical pharmacists can obtain more detailed and accurate drug list. It can reduce medication error and guarantee the safety of drug use to maximum extent that clinical pharmacists conduct medication reconciliation.
关键词
临床药师慢性肾功能不全药物重整药学实践
Keywords
Clinical pharmacistChronic renal insufficiencymedication reconciliationPharmacy practice
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1例乳腺癌合并静脉血栓栓塞患者的抗凝方案优化
Related Author
ZHU Yu-lin
ZHANG Yong
LIU Yan1
XING Rong
ZHANG Lingli
ZHANG Yang
ZENG Linan
CHEN Min
Related Institution
Dept. of Pharmacy, Second Affiliated Hospital, Army Medical University
Dept. of Pharmacy, Chongqing Health Center for Women and Children/Women and Children’s Hospital of Chongqing Medical University