Daniel Donna M, Casey Donald E, Levine Jeffrey L, Kaye Susan T, Dardik Raquel B, Varkey Prathibha, Pierce-Boggs Kimberly
Quality Measurement and Improvement, Atlantic Health, Morristown, New Jersey 07960, USA.
Acad Med. 2009 Dec;84(12):1788-95. doi: 10.1097/ACM.0b013e3181bf5b46.
The Accreditation Council for Graduate Medical Education recently emphasized the importance of systems-based practice and systems-based learning; however, successful models of collaborative quality improvement (QI) initiatives in residency training curricula are not widely available. Atlantic Health successfully conceptualized and implemented a QI collaborative focused on medication safety across eight residency training programs representing 219 residents. During a six-month period, key faculty and resident leaders from 8 (of 10) Atlantic Health residency training programs participated in three half-day collaborative learning sessions focused on improving medication reconciliation. Each session included didactic presentations from a multidisciplinary team of clinical experts as well as the application of principles that identified challenges, barriers, and solutions to QI initiatives. The learning sessions emphasized the fundamental principles of medication reconciliation, its critical importance as a vital part of patient handoff in all health care settings, and the challenges of achieving successful medication reconciliation improvement in light of work hours restrictions and patient loads. Each residency program developed a detailed implementation and measurement plan for individual "action learning" projects, using the Plan-Do-Study-Act method of improvement. Each program then implemented its QI project, and expert faculty (e.g., physicians, nurses, pharmacists, QI staff) provided mentoring between learning sessions. Several projects resulted in permanent changes in medication reconciliation processes, which were then adopted by other programs. The structure, process, and outcomes of this effort are described in detail.
毕业后医学教育认证委员会最近强调了基于系统的实践和基于系统的学习的重要性；然而，住院医师培训课程中协作质量改进（QI）举措的成功模式并不广泛存在。大西洋健康公司成功地构思并实施了一项QI协作项目，该项目专注于代表219名住院医师的八个住院医师培训项目中的用药安全。在六个月的时间里，来自大西洋健康公司10个住院医师培训项目中的8个项目的关键教员和住院医师负责人参加了三次为期半天的协作学习会议，重点是改进用药核对。每次会议都包括临床专家多学科团队的教学演示，以及识别QI举措的挑战、障碍和解决方案的原则应用。学习会议强调了用药核对的基本原则、其作为所有医疗环境中患者交接重要组成部分的至关重要性，以及鉴于工作时间限制和患者负荷实现成功的用药核对改进所面临的挑战。每个住院医师培训项目都使用改进的计划-执行-研究-行动方法，为各自的“行动学习”项目制定了详细的实施和测量计划。然后，每个项目都实施了其QI项目，专家教员（如医生、护士、药剂师、QI工作人员）在学习会议之间提供指导。几个项目导致了用药核对流程的永久性改变，随后被其他项目采用。详细描述了这项工作的结构、过程和结果。
