ผลของการพัฒนารูปแบบการบริบาลทางเภสัชกรรมเพื่อการจัดการเหตุการณ์ไม่พึงประสงค์จากยาที่ป้องกันได้ในผู้ป่วยศัลยกรรมทั่วไป

Abstract

The main objective of the study is to compare proportion of pADEs before and after implementation of pharmaceutical care development in general surgical patients. All male patients admitted to male general surgical ward at Songkhla hospital with a hospital stay at least 24 hours were included. The study was divided into three periods. In the first period, the researcher prospectively provided pharmaceutical care to the patients and collected the data regarding pADE. The detection of pADEs had been done by medical record review, patient and health care professional interview, direct observation, and voluntary incident reports by health care professionals. Two reviewers including a physician and a clinical pharmacist independently evaluated all incidents found on the first and third period. During the second period, pADES and MES found in the 1st period were analyzed and tools to prevent them were invented accordingly. In the third period, the tooled developed in the second period were implemented along with pharmaceutical care service. The data collection in the third period was done the same way as in the first period. Chi square test was used to compare proportion of pADES before and after implementation of pharmaceutical care development. The binary logistic regression analysis was used to assess the relationships between potential risk factors and MES. We found 247 patients with 1,628 patient-days and 231 patients with 1,298 patient-days in the 1st and 3rd period, respectively. The tools that were invented in the 2nd period and were implemented in the 3rd period including warfarin protocol, warfarin dosing chart, warfarin monitoring sheet, warfarin note, MR order form, MR sticker, KCl elixir pre- printed sticker. The incidence rates of pADEs were decreased from 3.07 per 1,000 patient-days in the 1st period to 0 per 1,000 patient-days in the 3rd period (p = 0.03). The occurrence rate of MEs in the 3rd period were lower than that found in the 1st period (OR = 0.522, 95% CI = 0.388 -0.701; p < 0.001) when ASA fitness grade and the number of medications on admission were adjusted. The incidence rates of MEs before and after implementation of pharmaceutical care tools were 44.84 and 17.72 per 1,000 patient-days, respectively. In conclusion, The tools that developed according to pADES and MES frequently found in the setting to prevent them to re-occur, was effective to decrease the incidence of pADEs.