RESUMO
BACKGROUND: The UK government currently recommends that all patients receive medicines reconciliation (MR) from a member of the pharmacy team within 24â hours of admission and subsequent discharge. The cost-effectiveness of this intervention is unknown. A pilot study to inform the design of a future randomised controlled trial to determine effectiveness and cost-effectiveness of a pharmacist-delivered service was undertaken. METHOD: Patients were recruited 7â days a week from 5 adult medical wards in 1 hospital over a 9 month period and randomised using an automated system to intervention (MR within 24â hours of admission and at discharge) or usual care which may include MR (control). Recruitment and retention rates were determined. Length of stay (LOS), quality of life (EQ-5D-3L), unintentional discrepancies (UDs) and emergency readmission (ER) within 3â months were tested as outcome measures. The feasibility of identifying and measuring intervention-associated resources was determined. RESULT: 200 patients were randomised to either intervention or control. Groups were comparable at baseline. 95 (99%) patients in the intervention received MR within 24â hours, while 62 (60.8%) control patients received MR at some point during admission. The intervention resolved 250 of the 255 UDs identified at admission. Only 2 UDs were identified in the intervention group at discharge compared with 268 in the control. The median LOS was 94â hours in the intervention arm and 118â hours in the control, with ER rates of 17.9% and 26.7%, respectively. Assuming 5% loss to follow-up 1120 patients (560 in each arm) are required to detect a 6% reduction in 3-month ER rates. CONCLUSIONS: The results suggest that changes in outcome measures resulting from MR within 24â hours were in the appropriate direction and readmission within 3â months is the most appropriate primary outcome measure. A future study to determine cost-effectiveness of the intervention is feasible and warranted. TRIAL REGISTRATION NUMBER: ISRCTN23949491.
Assuntos
Hospitalização , Erros de Medicação/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde/métodos , Alta do Paciente , Segurança do Paciente/estatística & dados numéricos , Farmacêuticos/economia , Idoso , Análise Custo-Benefício/economia , Feminino , Humanos , Tempo de Internação , Masculino , Readmissão do Paciente/estatística & dados numéricos , Segurança do Paciente/economia , Projetos Piloto , Reino UnidoRESUMO
Glycemic control in critically ill patients has become a subject of considerable interest since the publication of studies showing reduced morbidity and mortality in patients when blood glucose was maintained within a relatively low and narrow range (4.4 to 6.1 mM/L). We describe a patient who developed cardiac asystole while being given a concentrated glucose solution to treat severe hypoglycemia after administration of insulin. The mechanism in this patient appears to be hyperkalemia from the rapid administration of a concentrated glucose solution.