确定改善基层医疗中的用药安全的优先事项:一项患者用药安全问题和解决方案的优先设定和排序研究

发布时间：2018-11-24 10:11

【摘要】：背景用药疏失是一种频繁、有害且昂贵的患者安全事件。迄今为止的研究主要集中在医院中存在的用药疏失。本文旨在确定基层医疗中用药疏失的主要原因和解决方案。方法采用PRIORITIZE的优先次序制定方法,于2013年9月—2014年11月,邀请500名来自伦敦西北的基层医疗临床医生完成开放式问卷调查,以确定与基层医疗用药疏失有关的3个主要问题和解决方案。113名临床医生提交了问卷反馈,其中包括48个问题以及45个解决方案。从初始群组中随机选择57名临床医生对问题与解决方案进行评分,并获得总体排序。采用平均同意分值(AEA)评价临床医生评分的一致性。结果排在前3位的问题是:医生交接班期间用药治疗交接不充分,对患者药物使用的指导不足,以及出院医嘱较差。排名靠前的解决方案包括制定标准化的出院医嘱模板,减少不必要的处方和过多用药减到最少。医护人员和患者之间的沟通,在药物处方和用药监测期间的质量保证方法,以及对患者如何用药指导被认为是最应优先考虑的。排名最靠前的建议获得最高AEA评分。结论临床医生确定了一系列建议,以更好地进行用药管理,实施质量保证程序和开展患者用药指导教育。PRIORITIZE是一种新型的,方便的,系统的,并且可复制的方法,值得进一步探索,以便成为患者安全监测的常规预防机制中的一部分。
[Abstract]:Background Drug neglect is a frequent, harmful and expensive patient safety event. So far, the research has focused on drug neglect in hospitals. The purpose of this paper is to determine the main causes and solutions of drug neglect in primary medical care. Methods using the PRIORITIZE priority-setting method, 500 primary care clinicians from northwest London were invited to complete an open questionnaire from September 2013 to November 2014. 113 clinicians submitted questionnaire feedback, including 48 problems and 45 solutions. A total of 57 clinicians were randomly selected from the initial group to rate the problems and solutions. (AEA) was used to evaluate the consistency of clinicians' scores. Results the top three problems were: insufficient handover of medication and treatment, insufficient guidance on drug use, and poor discharge orders. Top-ranking solutions include developing standardized discharge advice templates, reducing unnecessary prescriptions and overdosing to a minimum. Communication between health care workers and patients, quality assurance methods during drug prescriptions and drug monitoring, and guidance to patients on how to use drugs are considered top priorities. The top ranked recommendations receive the highest AEA score. Conclusion clinicians have determined a series of suggestions for better drug administration, quality assurance procedures and patient drug guidance education. PRIORITIZE is a new, convenient, systematic and replicable method. It is worth further exploring in order to be part of the routine prevention mechanism of patient safety monitoring.
【分类号】：R969

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