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Ovrednotenje uvedbe usklajevanja zdravljenja z zdravili pri sprejemu in odpustu bolnikov na Oddelku za nefrologijo Klinike za interno medicino Univerzitetnega kliničnega centra Maribor
Fras, Daša (Avtor), Kerec Kos, Mojca (Mentor) Več o mentorju... Povezava se odpre v novem oknu, Drofenik, Polonca (Komentor)

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Izvleček
Namen usklajevanja zdravljenja z zdravili (UZZ) je zagotavljanje točnih in popolnih informacij o zdravljenju z zdravili pri prehajanju med različnimi ravnmi zdravstvene oskrbe. Z raziskavo smo želeli dokazati pomembnost vpeljave procesa UZZ ob sprejemu in ob odpustu v vsakdanjo klinično prakso, zato smo vanjo vključili 100 bolnikov, ki so se med marcem in novembrom 2019 zdravili na Oddelku za nefrologijo Klinike za interno medicino UKC Maribor. Pri 50 bolnikih v kontrolni skupini je bila opravljena le storitev UZZ ob sprejemu, ki se je izvajala že pred začetkom raziskave. V intervencijski skupini, v katero smo prav tako vključili 50 bolnikov, pa je bila opravljena storitev UZZ ob sprejemu in ob odpustu, ko so bolniki prejeli tudi osebno kartico zdravil. Mediana starosti bolnikov, ki so sodelovali v raziskavi, je bila 79 let, v skupini je bilo 61 % žensk. Kontrolna in intervencijska skupina sta bili po spolu, starosti in terapiji ob sprejemu in odpustu statistično primerljivi, značilno sta se razlikovali le v oceni glomerulne filtracije ob sprejemu, kar po našem mnenju ni vplivalo na rezultate raziskave. Bolniki so imeli ob sprejemu v povprečju 7 zdravil za redno terapijo (razpon 0–18) in 1 zdravilo za terapijo po potrebi (razpon 0–7). Kar 42,2 % zdravil za redno terapijo je bilo iz ATC skupine C. Ob sprejemu je bilo pri 44,0 % bolnikov prisotno vsaj eno namerno nedokumentirano ali nenamerno neskladje. Skupno smo ugotovili 78 tovrstnih neskladij pri 845 zdravilih (9,2 %). V intervencijski skupini je bilo značilno manj neskladij kot v kontrolni skupini (p = 0,009), predvsem zaradi odsotnosti namernih nedokumentiranih neskladij. Posledično sklepamo, da je med raziskavo medicinsko osebje dosledneje dokumentiralo vse namerne spremembe v terapiji. Najpogostejša neskladja ob sprejemu bolnikov so bila nenamerno manjkajoče zdravilo (41,0 %), nenamerno napačen odmerek pri redni terapiji (20,5 %) in namerna nedokumentirana ukinitev zdravila iz redne terapije (16,7 %). Delež neskladij je bil najvišji v ATC skupini C (38,5 %). Ob odpustu je bil delež bolnikov z vsaj enim neskladjem nekoliko višji, znašal je 65,0 %. Pri kontrolni skupini smo zaznali 97 tovrstnih neskladij (24,4 % vseh zdravil), medtem ko jih je bilo v intervencijski skupini 50 (11,2 % vseh zdravil), kar je skoraj pol manj. Značilno manjše število neskladij v intervencijski skupini v primerjavi s kontrolno skupino je zlasti posledica manjšega števila nenamernih neskladij v intervencijski skupini. Najpogosteje ugotovljena neskladja ob odpustu so bila nenamerno izpuščeno zdravilo za terapijo po potrebi (27,9 %), namerna nedokumentirana ukinitev zdravila za redno terapijo (21,1 %) in namerna nedokumentirana sprememba odmerka redne terapije (16,3 %). Odstotni delež neskladij je bil na račun terapije po potrebi najvišji v ATC skupini N (34,5 %), sledijo skupine C (23,6 %), A (15,5 %) in R (10,8 %). Zgolj 3 % bolnikov ob odpustu niso imeli nobene spremembe kronične terapije, skupno pa smo pri bolnikih zaznali 429 sprememb (razpon 0–12 na bolnika). Visok delež sprememb v kronični terapiji skupaj z značilno manjšim številom neskladij v intervencijski skupini v primerjavi s kontrolno skupino ob sprejemu in ob odpustu sta očitna pokazatelja, da je vpeljava storitve UZZ nujna tudi za druge oddelke UKC Maribor. Zato bi bilo smiselno pripraviti standardni operativni postopek, ki bi klinične farmacevte vodil skozi proces UZZ, poenotil njihovo delo in omogočil še boljše rezultate storitve.

Jezik:Slovenski jezik
Ključne besede:usklajevanje zdravljenja z zdravili, neskladja pri zdravljenju z zdravili, sprejem, odpust, zgodovina zdravljenja z zdravili, osebna kartica zdravil
Vrsta gradiva:Magistrsko delo/naloga (mb22)
Organizacija:FFA - Fakulteta za farmacijo
Leto izida:2021
Število ogledov:102
Število prenosov:36
Metapodatki:XML RDF-CHPDL DC-XML DC-RDF
 
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Sekundarni jezik

Jezik:Angleški jezik
Naslov:Assessment of implementation of medication reconciliation at admission and discharge of patients at the Department of Nephrology, Division of Internal Medicine, University Medical Centre Maribor
Izvleček:
The purpose of medication reconciliation (MR) is to provide accurate and complete information on medication treatment when switching between different levels of healthcare. The aim of our research was to prove the importance of the introduction of the MR at hospital admission and discharge in everyday clinical practice. For this purpose, we included 100 patients in the study. They were treated at the Department of Nephrology, Division of Internal Medicine, University Medical Centre Maribor in the period between March and November 2019. In the control group with 50 patients the MR service was performed only at admission. Also in the intervention group 50 patients were included, but the MR service was provided upon admission and discharge when patients also received a personal medication list. The median age of the included patients was 79 years and 61% of them were women. There were not significant differences between the control and intervention groups in gender, age, and therapy at admission and discharge. They differed significantly only in the glomerular filtration rate at admission, which, in our opinion, did not affect the results of the study. At admission patients received an average 7 medications for regular therapy (range 0–18) and 1 as needed medication (range 0–7). 42.2% of the medications for regular therapy were from the ATC group C. At admission, at least one intentional undocumented or unintentional discrepancy was present in 44.0% of patients. A total of 78 such discrepancies were identified in 845 medications (9.2%). There were significantly fewer discrepancies in the intervention group than in the control group (p = 0.009), mainly due to the absence of intentional undocumented discrepancies. Based on this, we can conclude that during the study medical staff documented all intentional changes in therapy more consistently. The most common discrepancies at admission were unintentionally omitted medication (41.0%) and unintentionally incorrect dose (20.5%) in regular therapy and intentional undocumented omission of the regular medication (16.7%). The portion of discrepancies was the highest in the medications from ATC group C (38.5%). At discharge, the percentage of patients with at least one discrepancy was slightly higher than at admission (65.0%). In the control group, we detected 97 such discrepancies (24.4% of all medications) while in the intervention group there were only half as many, namely 50 (11.2% of all medications). A significantly lower number of discrepancies in the intervention group compared to the control group is mainly the consequence of the lower number of unintentional discrepancies in the intervention group. The most common discrepancies at discharge were unintentionally omitted as needed medication (27.9%), intentional undocumented omission of regular medication (21.1%), and intentional undocumented dose adjustment of regular medication (16.3%). Due to as needed therapy, the portion of discrepancies was the highest in the ATC group N (34.5%), followed by groups C (23.6%), A (15.5%), and R (10.8%). Only 3% of patients had no change in chronic therapy at discharge. We detected a total of 429 changes in patients’ therapy (range 0–12 per patient). The high portion of changes in chronic therapy, together with the significantly smaller number of discrepancies in the intervention group compared to the control group at admission and discharge, are obvious indicators that the introduction of the MR is necessary also in other departments of the University Medical Centre Maribor. It would be reasonable to develop a standard operating procedure that would guide clinical pharmacists through the MR process, unify their work, and enable even better results.

Ključne besede:medication reconciliation, medication discrepancies, admission, discharge, medication history, personal medication list

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