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Évaluation de la saisie décentralisée des ordonnances sur l’unité des soins intensifs d’un établissement pédiatrique
| Content Provider | Semantic Scholar |
|---|---|
| Author | Nguyen, Bao Thuy Lebel, Denis Bussières, Jean-François |
| Copyright Year | 2001 |
| Abstract | ABSTRACT Objective: To determine the impact of changes in the ratio of pharmaceutical care to pharmaceutical services, resulting from implementation of a decentralized prescription entry system, on quality of care and services provided. Methods: A quasi-experimental study, without controls, conducted before (December 1998) and after (January 1999) decentralization of prescription order entry in an intensive care unit at the Sainte-Justine Hospital in Montreal, Quebec. Patients who received at least one prescription during their hospital stay between December 1998 and January 1999 were included in the study. Results: After implementation of decentralized prescription entry, reductions occurred in the total number of interventions (from 94 to 58) and the total number of interventions per prescription (from 0.17 to 0.12; p = 0.03). However, the proportion of interventions undertaken by the pediatric intensive care pharmacist increased from 69% to 91%, which suggests an increase in pharmacist time spent solving prescription-related problems. There was a statistically nonsignificant reduction in the mean number of interruptions per medical round, but no statistically significant difference in the mean total duration of interruptions (per day) or in the rate of participation in medical rounds. An expert panel evaluated the impact of the interventions on the therapeutic outcome and found that between 21% and 64% of the interventions had a positive therapeutic effect (major, moderate or low) before decentralization of order entry, whereas 50% to 71% of interventions had a positive effect after decentralization. The risks associated with a pharmacist’s intervention were also assessed. The risk reduction was 50% to 64% before decentralization and 36% to 64% after decentralization. The nursing staff were very satisfied with the proposed system and expressed a desire to maintain it after the study was complete. The number of information requests from nurses increased after completion of the study. Decentralized prescription entry would generate savings of about 500 hours per year (equivalent to $11 000). Conclusion: Changes in the ratio of pharmaceutical care to pharmaceutical services in a pediatric intensive care unit through implementation of a decentralized system for prescription entry allowed pharmacists to maintain the quality of pharmaceutical care and services and may contribute to cost reduction. If the time dedicated to order entry is about half of total time worked, it should be possible to deliver complete, high-quality pharmaceutical care to about 10 intensive care patients. Decentralized entry associated with pharmaceutical care delivery represents an interesting model that can better leverage pharmaceutical care and services; however, working procedures must be defined to avoid a situation where the pharmacist is confined to processing prescriptions and is thus unable to adequately deliver the necessary pharmaceutical care. RESUME Objectif : Determiner l’impact d’une modification du ratio des activites de soins/services pharmaceutiques sur la qualite des soins/services rendus par la decentralisation de la saisie des ordonnances. Methodologie : Etude d’evaluation quasi-experimentale, sans groupe temoin, comportant la phase pre-decentralisation et la phase post-decentralisation, sur une unite de soins intensifs de l’hopital Sainte-Justine a Montreal (Quebec). Les patients qui ont recu au moins une ordonnance durant leur sejour entre decembre 1998 et janvier 1999 ont ete admis a l’etude. Resultats : Suite a l’implantation d’un modele de saisie decentralisee des ordonnances associee a la prestation de soins pharmaceutiques, nous avons remarque une reduction du nombre total d’interventions (de 94 a 58) et du nombre total d’interventions/ordonnance (de 0,17 a 0,12; p = 0,03). Toutefois, le taux d’interventions effectuees par le pharmacien des soins intensifs pediatriques est passe de 69 a 91 %, ce qui suggere un accroissement de ses activites a resoudre des problemes lies aux ordonnances. Nous avons observe aussi une reduction statistiquement non significative de la moyenne du nombre d’interruptions/tournee medicale, mais aucune difference statistiquement significative quant a la moyenne de la duree totale des interruptions (/jour) ou au taux de presence a la tournee medicale. L’evaluation de l’impact par un comite expert des interventions sur l’effet therapeutique revele que de 21 a 64 % des interventions ont eu un effet therapeutique benefique (marque, modere ou faible) pour les patients durant la phase pre-decentralisation, comparativement a 50 a 71% pour les patients durant la phase post-decentralisation. Les risques associes a une intervention du pharmacien ont egalement ete evalues. Nous avons observe une diminution de 50 a 64 % de ce risque durant la phase pre-decentralisation, comparativement a une diminution de 36 a 64 % durant la phase post-decentralisation. Le personnel infirmier a ete tres satisfait du modele propose et souhaite qu’il soit maintenu au terme de l’etude. Le nombre de demandes d’information de la part du personnel infirmier a connu egalement une hausse suite a cette etude. La saisie decentralisee genere des economies d’environ 500 heures travaillees par annee (11 000 $). Conclusion : La modification du ratio soins/services pharmaceutiques par la saisie decentralisee des ordonnances permet de maintenir la qualite des soins et des services pharmaceutiques et peut contribuer a la reduction des couts dans une unite de soins intensifs pediatriques. Si le temps alloue aux services est d’environ 50 % des heures travaillees, on peut offrir des soins pharmaceutiques complets et de qualite pour une dizaine de patients des soins intensifs. La saisie decentralisee associee a la prestation des soins pharmaceutiques est un modele interessant qui peut ameliorer l’arrimage entre les soins et les services pharmaceutiques; toutefois, des modalites de fonctionnement doivent etre precisees pour eviter que le pharmacien ne soit confine a la saisie uniquement et qu’il ne puisse plus offrir adequatement les soins pharmaceutiques necessaires. |
| File Format | PDF HTM / HTML |
| DOI | 10.4212/cjhp.v54i1.613 |
| Volume Number | 54 |
| Alternate Webpage(s) | https://www.cjhp-online.ca/cshp/index.php/cjhp/article/download/613/724 |
| Alternate Webpage(s) | https://doi.org/10.4212/cjhp.v54i1.613 |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
