基于德尔菲专家咨询法构建稳定期精神分裂症康复方案的研究

目的 基于德尔菲专家咨询法,构建稳定期精神分裂症康复方案.方法 选取精神医学、精神心理学、护理学等专业的专家共20位,采用德尔菲专家咨询法,于2019年8月至2020年3月通过面对面、电子邮件等方式发送两轮问卷,并以文献回顾为基础,形成稳定期精神分裂症康复方案.结果 两轮咨询表回收率均为100.0％.两轮专家咨询的熟悉...     

基于改良德尔菲法构建盐城市《医疗机构药物警戒工作指南》

目的：构建地方标准《医疗机构药物警戒工作指南》（以下简称《指南》）,为盐城市医疗机构药物警戒工作提供指导。方法：在文献分析法和半结构访谈法的基础上,制定专家咨询问卷。采用改良德尔菲法开展3轮专家咨询,确定《指南》的三级条目。结果：第2和3轮均有30名专家参加咨询,问卷有效回收率为100%,专家权威系数分别为0.89和0.92,肯德尔和谐系数为0.309（P < 0.001）和0.404（P < 0.001）,各条目变异系数均小于0.25,Cronbach α系数分别为0.96和0.98。最终确定了《指南》条目包括一级条目9个,二级条目23个,三级条目21个。结论：《指南》条目的确立科学、可靠,对医疗机构构建药物警戒质量管理体系具有较高的指导意义。     

基于德尔菲法构建碳青霉烯类抗菌药物合理应用敏感指标

目的 构建碳青霉烯类抗菌药物合理应用敏感指标。方法 通过国内外文献检索和研究小组讨论,初步确立碳青霉烯类抗菌药物合理应用敏感性指标,并采用德尔菲专家函询法,对药学、医学及微生物检验人员各18名进行2轮函询,统计整理函询结果。结果 构建的碳青霉烯类抗菌药物合理应用敏感指标包括一级指标3项,二级指标11项和三级指标26项。2轮专家函询有效回收率分别为86.4%和94.7%,权威系数分别为0.83和0.88。第1轮总体协调系数0.169,第2轮总体协调系数0.304。3项一级指标的协调系数分别为0.414,0.308和0.311,经χ²检验后均有统计学意义（P<0.01）。结论 构建的碳青霉烯类抗菌药物合理应用敏感指标具有一定可信度,可为碳青霉烯类抗菌药物合理应用的管理与评价提供客观、可量化的评估工具。     

基于德尔菲法构建预防用质子泵抑制剂合理应用敏感指标

目的：构建预防用质子泵抑制剂合理应用敏感指标。方法：通过循证和小组讨论,初步确立预防用质子泵抑制剂合理应用敏感指标,并采用德尔菲专家函询法,对药学和医学人员共27名进行2轮函询, 统计整理函询结果。结果：构建的预防用质子泵抑制剂合理应用敏感指标包括一级指标3项、二级指标8 项和三级指标17项。2轮专家函询有效回收率分别为90%和100%。第二轮权威系数为0.80,总体协调系数 0.352,经检验具有统计学意义(P＜0.01)。结论：构建的预防用质子泵抑制剂合理应用敏感指标具有一定可信度,可为预防用质子泵抑制剂合理应用的管理与评价提供客观、可量化的评估工具。     

基于德尔菲法构建《中国妊娠期药物风险评估专家共识》

目的:基于德尔菲法构建《中国妊娠期药物风险评估专家共识》,为进一步开展妊娠期药物风险评估研究提供方法学基础.方法:参考妊娠期药物风险评估研究相关文献,撰写《中国妊娠期药物风险评估专家共识》,并设计专家咨询问卷.选取北京、上海等省市51名专家,应用德尔菲法进行两轮专家咨询,对《中国妊娠期药物风险评估专家共识》的内容进行修...     

基于德尔菲法构建集采中选药品管理敏感指标

目的：构建集采中选药品管理敏感指标。方法：通过循证初步建立集采中选药品管理敏感指标,再通过德尔菲专家函询法对30名药学人员进行2轮函询,并统计整理函询结果。结果：构建的集采中选药品管理敏感指标包括一级指标3项,二级指标11项和三级指标22项。两轮专家函询有效回收率分别为91%和100%。第二轮权威系数为0.82,总体协调系数0.434,检验具有统计学意义（P＜0.01）。结论：本研究构建的集采中选药品管理敏感指标满足专家积极程度、权威程度和一致性标准等各项标准。     

对心内科患者中进行药物重整基础上的出院带药教育及应用评价

目的:评估药物重整基础上的出院带药教育的作用。方法:对入住北京医院心内科病房的患者进行筛选并随机分组,仅对对照组患者提供出院带药教育资料,对试验组患者入院和出院进行药物重整服务,出院时在提供出院用药教育资料的基础对用药差异(包括有意差异和未修改的无意差异)和高风险药物进行面对面交流教育。患者出院后3个月进行对患者的再住院率、ADE、用药依从性、知识问卷评分进行随访调研。结果:两组间患者临床特征无显著差异。试验组入院药物重整发现医嘱差异351个,出院发现86个。知识问卷评分、依从性评分、患者报告的药品不良事件/用药错误次数(ADE/ME)试验组明显优于对照组。患者再住院两组无显著差异。结论:药师在药物重整基础上的进行患者出院带药教育,可以显著提高患者用药知识素养,同时降低院内外用药错误,增加患者院外的用药依从性。     

基于德尔菲法构建慢性病药物可及性评价指标体系

目的 构建慢性病药物可及性评价指标体系,为相关政策决策者与研究者开展慢性病药物可及性评价提供参考。方法 采用德尔菲法对20名专家开展2轮函询,就拟定的慢性病药物可及性评价指标体系进行评分。通过统计专家积极性、专家权威程度、专家意见集中程度与协调程度判断指标体系可靠性,基于界值法筛选指标,并结合专家意见对指标进行调整后确立最终的指标体系。结果 2轮函询的专家积极系数分别为92.31%与83.33%,专家权威系数分别为0.75与0.84,指标重要性得分均值分别为3.35与3.42,协调系数分别为0.183与0.239。调整后形成由4个维度、21项指标组成的慢性病药物可及性评价指标体系。结论 本研究基于德尔菲法设计的指标体系较可靠,可用作慢性病药物可及性的调查评价。     

病房药房药物咨询分类分析

我国临床药学起步较晚,经过十多年的发展,有了明显进步.就我院药剂科而言,过去一直停留在简单的进药发药阶段,目前,我们已成功地开展了常规化门诊药物咨询、病房药师审查药疗单及参加临床交接班和查房工作,还建立了临床电话咨询,受到临床医生和病人的欢迎.本文对2000年1～6月的162例咨询记录进行分析,以便积累经验,在今后更好地做好药物咨询服务.     

基于工作实践探讨药物重整的分级服务

目的 通过对慢病患者中开展的药物重整工作进行分析,探讨药物重整目标人群和分级服务。方法 2021年3月-2021年9月药师收集入住河南省国际医疗中心一病区诊断为高血压、糖尿病、冠心病患者的药物清单,开展药物重整工作并进行资料汇总分析。结果 共收集了252例患者的院外最可能收集的用药清单,共发现108个非故意用药差异（干预率42.85%）,对发现药物问题的患者进行Logistic因素分析发现老年、冠心病患者适宜开展药物重整,Ⅰ型干预中药物遗漏（40.00%）和用法用量差异（36.00%）比例较大,Ⅱ型干预主要集中在用法用量调整（31.00%）和依从性问题（21.00%）方面;Ⅰ型干预接受度为90.00%,Ⅱ型干预接受度为79.31%。结论 在老年及冠心病患者中适宜开展药物重整工作,建议通过信息化辅助和分级药学服务推动药物重整的广泛开展。     

The medication discrepancy taxonomy (MedTax): The development and validation of a classification system for medication discrepancies identified through medication reconciliation

BackgroundMedication discrepancies directly impact patient safety and can adversely impact quality of care and resource utilization at transitions of care.ObjectivesTo develop a common nomenclature and taxonomy for classifying and reporting medication discrepancies and to assess the content validity and reliability of the taxonomy.MethodsThe taxonomy was developed following a multi-stage process. The content of the taxonomy was then assessed using expert opinion through a two-round modified Delphi process. The expert panel comprised 10 experts who were selected based on pre-defined selection criteria. Six experienced pharmacists were then invited to classify medication discrepancies from a number of fictitious cases (adapted from authentic cases) using the taxonomy.ResultsThe medication discrepancy taxonomy (MedTax) comprises 12 main types and 28 sub-types of discrepancies. A set of operational instructions and definitions to aid the use of the taxonomy was formulated. The overall Average content validity index (Ave-CVI) was 0.93 and interrater reliability was 0.67 (multirater κfree), indicating substantial agreement. An excellent internal consistency of the taxonomy was established (Kuder–Richardson Formula 20 (KR-20) = 0.92).ConclusionsA content valid and reliable taxonomy for classifying medication discrepancies was developed. The MedTax may be used to classify medication discrepancies identified following medication reconciliation services. The clear and consistent reporting of medication discrepancies arising from medication reconciliation services may be of value to policy makers, healthcare professionals and researchers, when evaluating such services. The MedTax was designed to fill an essential void in global endeavors to reinforce standardization of medication reconciliation practices and to improve medication safety across transitions of care.     

Pharmacist-directed reconciliation for reducing medication discrepancies: A pilot study in a nursing home setting in Taiwan

Nursing home residents are at risk for medication errors when being transferred between wards. Medication reconciliation is a process used to verify medication use, identify variations and rectify medication errors during transitions. This pilot study was performed to evaluate a pharmacist-directed medication-reconciliation program in a nursing home setting. The number and types of discrepancies 3 months before (the control period) and after (the study period) implementation of a medication-reconciliation program were compared. A pharmacist performed medication reconciliation and discussed discrepancies with care providers in the study period. There were 190/209 (90.9%) and 220/266 (82.7%) documented discrepancies during the control and study periods, respectively. The major discrepancies found in both periods were the addition or omission of drugs. Of the 46 undocumented discrepancies in the study period, 13 (28.3%) were confirmed to be intentional changes. The suggestions made by the pharmacist were accepted in 19 of the remaining 33 undocumented (and unintentional) discrepancies. Eleven of 12 harmful discrepancies in the study period were corrected in a timely manner as a result of the medication-reconciliation program, that is, 91.7% of the harmful discrepancies were successfully prevented. But five (26.3%) harmful unintentional discrepancies of the 19 undocumented discrepancies in the control period could not be prevented from affecting patients. Pharmacist-directed medication reconciliation can reduce medication discrepancies in a nursing home setting in Taiwan.     

Defining and identifying concepts of medication reconciliation: An international pharmacy perspective

BackgroundMedication discrepancies occur in up to 80% of hospitalized patients during transitions of care, either at admission or discharge. However, numerous organization have different definitions of medication reconciliation which may result in variations of services being implemented.ObjectiveTo develop a consensus definition of medication reconciliation and define the essential components of medication reconciliation based on international consensus using a modified Delphi process.MethodsStatements and definitions about medication reconciliation found in the literature were used to build a Delphi Questionnaire and sent to experts around the world. Experts were identified based on their leadership in publication, education, professional interest and participation in the area of medication management. Delphi rounds continued until an 80% agreement was achieved.ResultsIn total, 24 experts were included in the Delphi panel. Three Delphi rounds were required to reach consensus on the key concepts included in a medication reconciliation. These concepts included 65 statements classified under (1) tasks involved, (2) who can conduct them, (3) when they should be conducted, (4) who should receive them, (5) how should it be measured and (6) clarifying the difference between medication reconciliation and medication review. This led to a proposed definition for medication reconciliation tasks as “the process of creating the most accurate list possible of all medications a patient is taking and comparing that list against the prescriber's orders. In addition, the patient's allergies, history of side effects from medications and medication aids are listed with the goal of providing correct medication to the patient at all transition points within the health care system.”ConclusionAn international expert panel was able to receive consensus on the definition of tasks involved in medication reconciliation and its essential concepts after four Delphi rounds. This definition is broader in scope than previous definitions.     

消化内科患者入院药物重整分析

目的:通过分析消化内科患者入院时药物重整情况,为临床药师参与消化内科患者入院时药物管理及用药指导提供参考.方法:选择2019年6月至2020年6月某院消化内科新入院患者,纳入入院前存在服用药物的病例,通过药学问诊,记录患者的用药目的、用法用量、慢病是否定期随访或监测指标值、过敏史.结果:共纳入111例病例,其中有慢病史...     

Effectiveness of a medication reconciliation project conducted by PharmD students

Objectives

This study evaluated the effectiveness of a medication reconciliation program conducted by doctor of pharmacy (PharmD) students during an advanced pharmacy practice experience.

Methods

Patients admitted to medicine or surgery units at 3 hospitals were included. Students were instructed to interview each patient to obtain a medication history, reconcile this list with the medical chart, and identify and solve drug-related problems.

Results

Eleven students reconciled medications for 330 patients over 10 months and identified 922 discrepancies. The median number of discrepancies found per patient was 2, and no discrepancies were found in 25% of the cases. In cases in which discrepancies were identified, a greater number of medications had been prescribed for the patient (7.9 ± 4.0 medications compared to 5.4 ± 3.9 medications; p < 0.05). The students completed 59 interventions. Differences were found in the numbers of discrepancies and drug-related problems that different students at different sites identified (p < 0.05).

Conclusions

Pharmacy students provided a valuable service to 3 community hospitals. The students improved the quality of patient care by identifying and solving significant drug-related problems, identifying drug allergy information, and resolving home and admission medication discrepancies.     

临床药师在肾内科实施入院药物重整的实践

目的：临床药师通过在肾内科实施入院药物重整服务,总结入院重整常见的用药错误并给予干预,探讨肾内科药物重整的工作模式及作用。方法：以2016年3月-2016年12月收入某院肾内科的住院患者为研究对象,在入院24 h内,获得患者入院前的用药史,并与患者入院后医师开取的医嘱进行对比。分析评估患者入院前用药和入院后医师医嘱有无用药错误。结果：共对128例患者进行了药物重整,存在用药错误的有62例,用药错误发生率为48.4%。涉及药物医嘱838条,发生用药错误的医嘱为81条。入院前患者服药时间错误,入院后用药频次错误,需停用药物未停用为最常见的用药错误。发生用药错误的药物中,前3位分别为消化道及代谢药物、心血管系统药物、抗肿瘤药和免疫机能调节药。81条用药错误中患者服药时间错误及患者随意改变推荐剂量共34条,临床药师及时给予患者进行教育和指导,均被患者接受。其余的47条用药错误,临床药师全部反馈给医师,40条被医师接受并修改,接受率为85.1%。结论：实施药物重整,可以发现并纠正患者服药时间错误、随意改变推荐剂量等用药问题;可以有效地减少医师在入院及转科等医疗转接点用药错误的发生,促进患者安全合理地使用药物。     

临床药师开展药物重整的药学服务实践

目的:为临床药师开展药物重整的药学实践提供参考。方法:探讨临床药师在实践工作中如何通过掌握用药史,及引入诺氏评估量表进行不良反应分析为切入点实现药物重整的药学服务实践。结果和结论:临床药师在药物重整工作中扮演着重要的角色。在临床实践中,临床药师获取精确的用药清单,加强专业知识地学习,借助一些适当的工具,才能实现药物重整。     

供方视角药物重整发生率与诱发因素分析

目的： 调查药物重整供方相关医务人员药物重整发生率,分析可能诱发药物重整供方相关医务人员行为的因素。方法： 于2019年4月至2019年9月,在湖北省武汉市内选取18家不同类别医疗机构,采用横断面调查,通过线上分发调查问卷,向有关医务人员了解药物重整发生的基本情况,并使用二元Logistic回归模型分析药物重整行为发生的影响因素。结果： 研究最终纳入214例医务人员,药物重整发生率为73.83%;单因素分析结果显示,医务人员所在医疗机构类别（P=0.001）、执业资格（P=0.001）、是否了解药物重整（P=0.002）、是否通过同行交流了解药物重整（P=0.002）、是否主动关注患者全面用药情况（P=0.001）与其药物重整行为的发生具有相关性,且差异具有统计学意义（P<0.05）。Logistic回归结果显示,执业资格、是否了解药物重整、是否通过同行交流了解药物重整和是否主动关注患者全面用药情况是诱发药物重整供方行为的独立影响因素。结论： 虽然样本医务人员药物重整发生率较高,但他们对药物重整的认知程度不足。药物重整行为的发生是医务人员不同执业资格、是否了解药物重整、会否通过同行交流获取药物重整知识和会否主动关注患者全面用药情况多个因素影响的结果。     

Development of a list of high-risk perioperative medications for the elderly: a Delphi method

Objectives: There is a lack of direct evidence for the management of perioperative medications in elderly patients. Therefore, the authors aimed to develop a list of high-risk medications for the elderly population in China to provide indicators for clinicians to identify medication-related factors contributing to potential adverse events during the perioperative period.

Methods: The initial list of high-risk perioperative medications was developed by studying all the publications that described specific high-risk medications and their risk profiles in the elderly. Delphi consultations were performed to form a consensus among the group of experts and the list was finalized.

Results: The expert panel consisted of 36 experts from 29 tertiary hospitals and 18 provinces or municipalities. The consensus was reached after two Delphi rounds. Finally, a total of 86 medications of 13 medication classes and 120 screening items were included in the final list, along with perioperative risk profiles and risk aversion recommendations for each drug.

Conclusion: This is the first study to establish a high-risk perioperative medication list in China, which can be used as a reference for intervention and evaluation of perioperative medications for the elderly population.