Rask Kimberly, Culler Steven, Scott Tracy, Kohler Susan, Hawley Jonathan, Friedman Esther, Naylor Dorothy Vi
Emory Center on Health Outcomes and Quality, Rollins School of Public Health, Atlanta, Georgia 30322, USA.
J Hosp Med. 2007 Jul;2(4):212-8. doi: 10.1002/jhm.187.
To reduce medical errors, the National Quality Forum (NQF) developed consensus-based guidelines of 30 safe practices recommended for all hospitals
To determine the hospital characteristics and barriers that influence the rates of adoption of these practices.
Retrospective review of annual self-assessment surveys from 2003 to 2004. Medication and culture of safety questions from the survey were mapped to the relevant NQF safe practices.
One hundred and forty-eight acute care hospitals.
Bivariate analysis was used to examine variation in adoption rates by hospital demographic characteristics.
Most hospitals had adopted 7 of the 9 medication-related practices. Lower adoption rates were seen for resource-intensive safe practices such as consultant pharmacists (52.0%) or CPOE (2.7%). The safety culture questions showed broad diffusion of nonpunitive error reporting (83.7%) but more limited adoption of proactive processes to detect and prevent errors (44.9%). There were no differences by urban versus rural setting and few differences by hospital size. Safe practices that affected hospital-based physicians such as ensuring that new prescribers had access to all currently prescribed medications and minimizing distractions during order writing were difficult for many hospitals. Lower adoption rates were also seen for processes requiring direct physician participation such as eliminating verbal orders and using standardized abbreviations.
Adoption of NQF-recommended safe practices appeared related to resource constraints and hospital culture. Promoting physician involvement as clinical leaders and team builders, moving from reactive reporting systems to proactive processes that prevent errors, and developing more robust monitoring systems will facilitate further adoption of safe practices.
为减少医疗差错，美国国家质量论坛（NQF）制定了基于共识的指南，推荐了30项适用于所有医院的安全措施。
确定影响这些措施采用率的医院特征和障碍。
对2003年至2004年年度自我评估调查进行回顾性分析。将调查中的用药和安全文化问题与相关的NQF安全措施进行映射。
148家急症护理医院。
采用双变量分析来检验医院人口统计学特征对采用率的差异。
大多数医院采用了9项与用药相关措施中的7项。资源密集型安全措施的采用率较低，如顾问药师（52.0%）或计算机化医师医嘱录入系统（CPOE，2.7%）。安全文化问题显示，非惩罚性差错报告广泛传播（83.7%），但主动发现和预防差错流程的采用更为有限（44.9%）。城市与农村地区之间没有差异，医院规模之间的差异也很少。对许多医院来说，影响医院医生的安全措施，如确保新处方医生能够获取所有当前开具的药物，以及在开医嘱时尽量减少干扰，都很困难。对于需要医生直接参与的流程，如取消口头医嘱和使用标准化缩写，采用率也较低。
采用NQF推荐的安全措施似乎与资源限制和医院文化有关。促进医生作为临床领导者和团队建设者的参与，从被动报告系统转向主动预防差错流程，并开发更强大的监测系统，将有助于进一步采用安全措施。
