Cozart Heidi, Horvath Monica M, Long Andrea, Whitehurst Julie, Eckstrand Julie, Ferranti Jeffrey
Duke Health Technology Solutions, Duke University Health System, 2424 Erwin Road, Durham, NC 27705, USA.
Qual Manag Health Care. 2010 Oct-Dec;19(4):282-91. doi: 10.1097/QMH.0b013e3181fa0680.
The authors report on the managerial and logistical details of deploying a computerized adverse drug event surveillance system that was at first a grant-funded research project and ultimately was changed to a sustained safety-monitoring application serving 3 different hospitals.
Surveillance was deployed in 3 phases to 2 community-based hospitals and an academic medical center. A logic-based rules engine surveyed electronic records for laboratory, medication, and demographic information indicative of safety concerns. Potential adverse events triggered manual chart review by pharmacists to verify patient harm.
During Phase 1, the research team created trigger rules for each hospital. In Phase 2, the trigger review was transitioned to hospital personnel and rule sets were reshaped for specific hospital needs. In Phase 3, surveillance was integrated into daily work flows and organizational balanced scorecards where it was accepted as a quantitative measure of medication safety performance.
Computerized surveillance helps detect potentially harmful events regardless of hospital size. Active leadership, change-tolerant culture, and hospital pharmacy practice models significantly impact successful adoption. Entrenched cultural issues impeded sustainability at the academic center but not at the 2 community hospitals. Tailoring surveillance to the needs of different inpatient settings is crucial to developing a sustainable model.
作者报告了部署一个计算机化药品不良事件监测系统的管理和后勤细节，该系统最初是一个由拨款资助的研究项目，最终转变为一个为3家不同医院提供持续安全监测的应用程序。
监测分三个阶段部署到2家社区医院和1个学术医疗中心。一个基于逻辑的规则引擎对电子记录进行调查，以获取表明安全问题的实验室、用药和人口统计学信息。潜在的不良事件触发药剂师进行人工病历审查，以核实患者是否受到伤害。
在第一阶段，研究团队为每家医院创建了触发规则。在第二阶段，触发审查工作转交给医院工作人员，并根据医院的特定需求对规则集进行了调整。在第三阶段，监测被整合到日常工作流程和组织平衡计分卡中，并被视为衡量用药安全绩效的一项量化指标。
计算机化监测有助于发现潜在的有害事件，无论医院规模大小。积极的领导、容忍变革的文化以及医院药房实践模式对成功采用该系统有重大影响。根深蒂固的文化问题阻碍了学术中心的可持续发展，但在2家社区医院并未出现这种情况。根据不同住院环境的需求定制监测对于建立一个可持续的模式至关重要。
