Usklajevanje zdravljenja z zdravili na internem oddelku in na oddelku za podaljšano bolnišnično zdravljenje Splošne bolnišnice Ptuj

magistrska naloga

Maruša Žagar (Avtor), Tomaž Vovk (Mentor), Danilo Salemović (Komentor)

Povzetek

Usklajevanje zdravljenja z zdravili je postopek preverjanja skladnosti bolnikove terapije pred sprejemom s terapijo ob sprejemu, prehodu ali odpustu iz bolnišnice, katerega osnovni namen je zmanjšati pogostost napak, povezanih z zdravili. Gre za tristopenjski proces, ki zajema pridobitev čim boljše zgodovine zdravljenja z zdravili in primerjavo s sedanjo terapijo, identifikacijo neskladij, odpravo neskladij ter uskladitev terapije in svetovanje bolniku o zdravilih in terapiji. Z raziskavo smo ţeleli izvesti usklajevanje zdravljenja z zdravili v Splošni bolnišnici Ptuj. Te storitve se v bolnišnici zaenkrat še ne posluţujejo, zato smo si kot začetek zadali izvedbo raziskave na področju usklajevanja zdravljenja z zdravili. S tem smo ugotovili trenutno stanje in ali je storitev v bolnišnici smiselna. Za začetek smo si izbrali dva med seboj zelo različna oddelka, in sicer interni oddelek ter oddelek za podaljšano bolnišnično zdravljenje, saj ţelimo, da so rezultati čim bolj prenosljivi med oddelki. V raziskavo smo vključili 100 naključno izbranih bolnikov iz obeh oddelkov, katerih povprečna starost je bila 80,0 let. Bolniki so skupaj prejemali 878 zdravil, kar je v povprečju 8,8 zdravil na bolnika. Največ zdravil je bilo iz N skupine po ATC klasifikaciji. Neskladje smo zaznali pri 60 (60 %) bolnikih, ga klasificirali, našli rešitev za odpravo in nato predstavili lečečemu zdravniku. Skupaj smo zaznali 151 neskladij, kar predstavlja 1,5 neskladij na bolnika. Najpogostejše ugotovljeno neskladje je bilo neskladje v odmernem intervalu, drugo pa izpuščeno zdravilo. Vsa neskladja smo predstavili lečečim zdravnikom na oddelkih. Preverjali smo, ali je prišlo do sprejetja neskladij in vpisa na temperaturni list. Ti so neskladja upoštevali v 19,9 %, delno pa v 5,3 %. Po končani analizi rezultatov smo lahko potrdili hipoteze, da bo vsaj 1/3 bolnikov imela 1 neskladje, da bo največ neskladij pri zdravilih iz C skupine po ATC klasifikaciji in da bo lečeči zdravnik več neskladij upošteval na oddelku za podaljšano bolnišnično zdravljenje. Ovrgli smo hipotezo, da bo več neskladij na oddelku za podaljšano bolnišnično zdravljenje. Kljub temu, da bolniki na oddelek za podaljšano bolnišnično zdravljenje prihajajo iz različnih oddelkov in ustanov ter da zdravila na internem oddelku občasno pregleduje farmacevt specialist, je na internem oddelku več neskladij. Kljub relativno majhnemu odstotku sprejetih neskladij (19,9 % sprejetih in 5,3 % delno sprejetih), menimo, da je proces usklajevanja zdravljenja z zdravili koristen, saj ima velik odstotek bolnikov prisotno vsaj eno neskladje. V raziskavi smo storitev usklajevanja izvedli le ob sprejemu, smiselno pa bi jo bilo narediti tudi ob odpustu oz. ob premestitvah med oddelki ali ustanovami.

Ključne besede

zdravljenje z zdravili;usklajevanje zdravljenja z zdravili;zgodovina zdravljenja;napake pri zdravljenju;neskladja pri zdravljenju;Rüde;Georg W.;

Podatki

Jezik:	Slovenski jezik
Leto izida:	2018
Tipologija:	2.09 - Magistrsko delo
Organizacija:	UL FFA - Fakulteta za farmacijo
Založnik:	[M. Žagar]
UDK:	615: 616-085(043.3)
COBISS:	4470129
Št. ogledov:	391
Št. prenosov:	79
Ocena:	0 (0 glasov)
Metapodatki:

Ostali podatki

Sekundarni jezik:	Angleški jezik
Sekundarni naslov:	Medication reconciliation on the internal department for extended hospital treatment in the General Hospital Ptuj
Sekundarni povzetek:	Medication reconciliation is a formal process to ensure the compliance of the patient’s therapy before admission to the hospital, during hospitalization and after discharge. The main purpose is to reduce the occurrence of medication related errors. It is a three-step process that includes: obtaining the best possible history of medical treatments and a comparison of the current medical treatments, identifying discrepancies, eliminating discrepancies and coordinating the therapy, as well as advising the patient on medication and therapy. With this research, we wanted to implement medication reconciliation at Ptuj General Hospital. This process is currently not being used by the hospital, therefore we wanted to do a research in this field. We established the current situation and whether this service is reasonable in the hospital. We chose two very different departments, i.e. the department for extended hospital treatment and the internal medicine department because we wanted the results to be applied to different departments. The research included 100 randomly selected patients from both departments, whose average age was 80 years. The patients received 878 medications in total, which is on average 8.8 medications per patient. The majority of the medications were from the N group according to the ATC classification. Discrepancies were recognised in 60 (60%) patients that were classified, we found a solution to eliminate them and presented them to the attending doctor. Through the research, 151 discrepancies were identified which equals to 1.5 discrepancies per patient. The first most recurrent discrepancy identified was the inconsistency in the dosing interval and the second missed medication. Our findings were presented to the department doctors. We checked if the discrepancies were accepted and entered into the temperature sheet. Our results were taken into account in 19.9 % and partially in 5.3 % of cases. After analysing the results, we can confirm the hypothesis that at least 1/3 of patients would have 1 discrepancy, that most discrepancies would be in the C group of drugs according to the ATC classification and that the attending doctor in the department for extended hospital treatment would take into account more discrepancies. We dismissed the hypothesis that there are more discrepancies in the department for extended hospital treatment. Despite the fact that patients come to the department for extended hospital treatment from various departments and institutions, and that medications in the internal medicine department are sometimes checked by a pharmacist, there are still more discrepancies in the internal medicine department. Despite the relatively small percentage of discrepancies (19.9 % accepted and 5.3 % partially accepted), we believe that the medication reconciliation process is useful because there was at least one discrepancy in a large percentage of patients (60 %). In the research, the medication reconciliation was carried out at admission, it would however also be reasonable to carry it out at discharge or transfer between departments or institutions.
Sekundarne ključne besede:	Zdravila;
Vrsta dela (COBISS):	Magistrsko delo/naloga
Komentar na gradivo:	Univ. Ljubljana, Fak. za farmacijo
Strani:	X, 53 f.
ID:	12042775