A multifaceted intervention to reduce drug-related complications in surgical patients.

Autor: Bos JM; Department of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands., van den Bemt PM; Department of Clinical Pharmacy, Erasmus University Medical Centre, Rotterdam, the Netherlands., Kievit W; Department of Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands., Pot JL; Department of Clinical Pharmacy, Meander Medical Centre, Amersfoort, the Netherlands., Nagtegaal JE; Department of Clinical Pharmacy, Meander Medical Centre, Amersfoort, the Netherlands., Wieringa A; Department of Clinical Pharmacy, Isala Hospital, Zwolle, the Netherlands., van der Westerlaken MM; Department of Clinical Pharmacy, Meander Medical Centre, Amersfoort, the Netherlands., van der Wilt GJ; Department of Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands., de Smet PA; Department Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands., Kramers C; Department of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.; Department of Clinical Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, the Netherlands.
Jazyk: angličtina
Zdroj: British journal of clinical pharmacology [Br J Clin Pharmacol] 2017 Mar; Vol. 83 (3), pp. 664-677. Date of Electronic Publication: 2016 Nov 10.
DOI: 10.1111/bcp.13141
Abstrakt: Aim: The P-REVIEW study was a prospective, multicenter, open intervention study, designed to determine whether a multifaceted intervention of educating the prescriber combined with medication review and pharmaceutical visits to the ward by the hospital pharmacist could lead to a reduction in drug-related complications among surgical patients.
Methods: A total of 6780 admissions of 5940 patients to surgical, urological and orthopaedic wards during the usual care period and 6484 admissions of 5711 patients during the intervention period were included. An educational programme covering pain management, antithrombotics, fluid and electrolyte management, prescription in case of renal insufficiency and antibiotics was developed. National and local hospital guidelines were included. Hospital pharmacists performed medication safety consultations, combining medication review of high-risk patients and a visit to the physician on the ward.
Results: A significantly lower proportion of admissions with one or more clinically relevant, potentially preventable, drug-related problems (including death, temporary or sustained disability, increased length of hospital stay or readmission within 30 days) occurred in the intervention period (1.1% (73/6484) compared to the usual care period [1.6% (106/6780)] (P = 0.029). The relative risk (RR) was 0.72 (95% CI 0.53-0.97). Several types of drug-related problems occurred less frequently. Costs incurred as result of time spent on study-related activities were not different before and after the intervention.
Conclusions: The P-REVIEW study shows that education and support of the prescribing physician with respect to high-risk patients in surgical departments leads to a significant, clinically relevant benefit for patients without generating additional costs.
(© 2016 The British Pharmacological Society.)
Databáze: MEDLINE
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