减少可预防的时间关键剂量遗漏:电子药物管理系统对住院病人的影响。

Linda V Graudins, Stephanie Crute, Susan G Poole, Gordon Bingham, Michael J Dooley
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引用次数: 0

摘要

背景:漏服时间紧迫的药物可能会导致不良的病人预后。有关包括自动配药柜(ADC)在内的电子药物管理系统(EMM)对及时用药的影响的文献很少。本研究旨在评估电子用药管理系统(包括自动配药柜)在实施 6 个月和 30 个月后对及时用药的影响,重点关注可预防的时间关键性药物剂量遗漏和记录在案的未用药原因:方法:从电子用药记录(EMR)中获取2019年3月的1周和2021年3月的4周内常规住院病人未给药剂量的数据。漏服是指在下一次应服剂量之前没有服药。时间紧迫的药物是根据医疗服务指南定义的。未给药的原因来自于数字健康报告中整理的 EMR 中的护理记录。时间关键型药物未给药的原因被定义为 "有效 "或 "可预防":2019 年和 2021 年,分别对 620 名和 2524 名患者的 44756 次和 146940 次计划用药剂量进行了审查。其中,分别有 4385 人(9.8%)和 19610 人(13.4%)未服药。在 2019 年和 2021 年,分别有 593 例(1.3%)和 1811 例(1.2%),p p = 0.015)。有 ADC 的病房与没有 ADC 的病房相比,时间紧迫的漏服率明显较低(1.1% vs 1.3%,p = 0.014):结论:随着 EMM 系统的引入,在 24 个月的时间里,时间紧迫的药物漏服率有所下降,包括可预防的漏服率也有所下降。定期评估时间紧迫的用药情况将有助于有针对性地改善患者安全。
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Reduction in preventable time-critical dose omissions: impact of electronic medication management systems on in-patients.

Background: The omission of time-critical medication doses may result in poor patient outcomes. There are few publications about the influence of electronic medication management (EMM) systems, including automated dispensing cabinets (ADC), on timely medication administration. The study aimed to evaluate the influence of EMM systems, including ADCs, on timely medication administration 6 and 30 months after EMM implementation, focussing on preventable time-critical medication dose omissions and documented reasons for not administering a dose.Methods: Data on doses of regular inpatient medications not administered were obtained from electronic medication records (EMR) over 1 week in March 2019 and 4 weeks in March 2021. An omission was a dose not administered before the next due dose. Time-critical medications were defined using the health service's guidelines. Reasons for doses not being administered were obtained from nursing documentation in the EMR collated from digital health reports. Reasons for time-critical medication doses not given were defined as 'valid' or 'preventable'.Results: In 2019 and 2021, 620 and 2524 patients with 44,756 and 146,940 scheduled medication doses were reviewed. Of these, 4385 (9.8%) and 19,610 (13.4%) doses were not administered. In 2019 and 2021, there were 593 (1.3%) and 1811 (1.2%), p < 0.0001, time-critical doses not administered. Preventable time-critical dose omissions decreased from 0.20% in 2019 to 0.15% (p = 0.015) in 2021. Wards with ADCs had a significantly lower rate of time-critical dose omissions compared to those without ADCs (1.1% vs 1.3%, p = 0.014).Conclusion: With the introduction of an EMM system, there was a decrease in the rate of time-critical medications not administered, including a reduced rate of preventable omissions over the 24-month period. Regular assessment of time-critical medication administration will help target patient safety improvements.

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