建立帕金森病住院护理质量的框架:关于住院药物管理的研究
Jeryl Ritzi T Yu1, Claire Sonneborn2, Olivia Hogue2
1Center for Neurological Restoration, Department of Neurology, Neurological Institute, Cleveland Clinic, OH, United States; Institute for Neurosciences, St. Luke's Medical Center, Quezon City and Global City, Philippines; University of the East Ramon Magsaysay Memorial Medical Center, Philippines.
Parkinsonism & related disorders
|July 26, 2023
概括
帕金森病 (PD) 患者在住院期间的药物偏差是常见的,并且与更糟糕的结果有关. 确保一致的药物管理对于改善患者护理和减少医院再入院至关重要.
科学领域:
- 神经学 神经学
- 临床药房 临床药房
- 患者安全 患者安全
背景情况:
- 帕金森病 (PD) 的管理涉及复杂的药物治疗方案.
- 患有PD的患者容易因治疗复杂性而导致药物偏差.
- 门诊和住院患者之间药物管理的差异可能会影响PD患者的治疗结果.
研究的目的:
- 为了确定住院PD患者药物偏差的频率.
- 调查与这些药物偏差相关的结果.
- 分析特定偏差的影响,例如莱沃多巴每日相当剂量 (LEDD) 变化和抗兴奋剂药物管理,对患者的结果.
主要方法:
- 在12个月内对PD患者的725次住院病例进行了回顾性分析.
- 门诊药物治疗方案与住院患者的药物管理记录的比较.
- 评估偏差,包括LEDD差异,时间错误,配方替代和抗多巴胺药物使用.
- 后勤回归分析与停留时间 (LOS),再接收率和死亡率的关联.
主要成果:
- 观察到显著的偏差率:43%的LEDD偏差,19%的Levodopa配方替代品,47%的时间偏差 (>30分钟),22%的Levodopa剂量遗漏.
- 所有类型的药物偏差 (过量,不足,错过剂量,时间偏差,替代) 都与增加的LOS显著相关 (p < 0.0001).
- 服用抗兴奋剂药物与更高的30天再入院/死亡 (OR 1.85) 和90天死亡率 (OR 2.2) 有关. 低剂量的LEDD也与30天再入院/死亡 (OR 1.78) 和90天死亡率 (OR 1.14) 的增加有关.
结论:
- 在PD患者中,门诊和住院设置之间的药物偏差很常见.
- 这些偏差,以及服用抗多巴胺药物,与不良结果有关,包括更长的住院时间和增加的死亡率.
- 在住院期间优化药物管理对于改善帕金森病患者安全和临床结果至关重要.
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