Wessell A M, Litvin C, Jenkins R G, Nietert P J, Nemeth L S, Ornstein S M
Department of Family Medicine, Medical University of South Carolina, 295 Calhoun Street, Charleston, SC 29425, USA.
Qual Saf Health Care. 2010 Oct;19(5):e21. doi: 10.1136/qshc.2009.034678. Epub 2010 Apr 22.
Medication errors have been associated with poor patient outcomes and pose significant public health consequences. Establishing medication safety quality indicators is crucial to capturing the pervasiveness of preventable errors and is a fundamental first step in the process of improvement. In this article, a study is presented in which a set of medication prescribing and monitoring quality indicators were developed, and adherence to them was assessed among a group of US primary care practices.
Twenty Practice Partner Research Network practices in 14 US states with 94 clinicians and 52,246 active adult patients participated in the study. All practices use a common electronic medical record with dosing, interaction and monitoring decision support features. A consensus development process was used to select indicators in the categories of inappropriate treatment, dosing, drug-drug and drug-disease interactions, and monitoring of potential adverse events. Data extracted electronically from practices' electronic medical record were used to assess practice-level adherence with the indicator set as of 1 July 2008.
Thirty medication safety indicators were selected. Across all practices, inappropriate treatment, dosing, drug-drug and drug-disease interactions were avoided in 75%, 84%, 98% and 86% of eligible patients, respectively; monitoring of preventable adverse drug events occurred in 75% of patients. There was wide variability in practice adherence with the indicators.
The consensus development process was successful in selecting a broad set of primary care medication safety quality indicators. Although aggregate adherence was relatively high in this group of practices, opportunities exist to improve potential errors in treatment selection, dosing and monitoring.
用药错误与不良患者结局相关，并造成重大的公共卫生后果。建立用药安全质量指标对于掌握可预防错误的普遍性至关重要，并且是改进过程中的基本第一步。本文介绍了一项研究，其中制定了一套用药处方和监测质量指标，并在一组美国初级保健机构中评估了对这些指标的遵守情况。
来自美国14个州的20个实践伙伴研究网络机构，有94名临床医生和52246名成年活跃患者参与了该研究。所有机构都使用具有剂量、相互作用和监测决策支持功能的通用电子病历。采用共识制定过程来选择不适当治疗、剂量、药物相互作用和药物疾病相互作用以及潜在不良事件监测等类别的指标。从机构的电子病历中电子提取的数据用于评估截至2008年7月1日各机构对指标集的遵守情况。
选择了30个用药安全指标。在所有机构中，分别有75%、84%、98%和86%的合格患者避免了不适当治疗、剂量、药物相互作用和药物疾病相互作用；75%的患者接受了可预防药物不良事件的监测。各机构对指标的遵守情况差异很大。
共识制定过程成功地选择了一套广泛的初级保健用药安全质量指标。尽管这组机构的总体遵守率相对较高，但在治疗选择、剂量和监测方面仍有改进潜在错误的机会。
