College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA.
J Patient Saf. 2010 Dec;6(4):238-43. doi: 10.1097/pts.0b013e3181fe401f.
Electronic health record (EHR) systems offer promising tools to assist clinicians and staff with improving medication safety, yet many of the decision support components within these information systems are not well used. The aim of this study was to identify the strategies planned by primary care practices participating in a 2-year medication safety quality improvement intervention within the Practice Partner Research Network.
A theoretical model for primary care practice improvement was used to foster team-based approaches to prioritizing performance, system redesign, better use of EHR tools, and patient activation. The intervention included network meetings, site visits and performance reports. Improvement plans were qualitatively evaluated from field notes and organized to present a comprehensive approach to improving medication safety in primary care using EHRs.
A total of 32 distinct plans and 11 common strategies were developed by practices to improve adherence with prescribing and monitoring indicators. Common plans included enhancing medication reconciliation to improve the accuracy of medication lists, using Practice Partner Research Network reports to identify patients meeting criteria for preventable medication errors, and customizing and applying EHR decision support tools for medication dosing, drug-disease interactions, and monitoring.
Medication safety might be improved by implementing specific strategies within the primary care setting. Further evaluation is needed to provide an evidence base for improvement.
电子健康记录（EHR）系统为协助临床医生和工作人员提高用药安全性提供了有前景的工具，但这些信息系统中的许多决策支持组件并未得到很好的利用。本研究旨在确定参与实践合作伙伴研究网络为期两年的用药安全质量改进干预措施的初级保健实践计划采用的策略。
使用一个针对初级保健实践改进的理论模型来促进以团队为基础的方法，以确定绩效优先级、系统重新设计、更好地利用 EHR 工具以及患者激活。该干预措施包括网络会议、现场访问和绩效报告。从实地记录中定性评估改进计划，并组织起来，展示使用 EHR 改善初级保健用药安全性的综合方法。
共有 32 个不同的计划和 11 个共同的策略是由实践制定的，以提高遵守处方和监测指标的依从性。常见的计划包括加强用药核对以提高用药清单的准确性，使用实践合作伙伴研究网络报告确定符合预防用药错误标准的患者，以及定制和应用 EHR 决策支持工具进行药物剂量、药物-疾病相互作用和监测。
在初级保健环境中实施特定策略可能会提高用药安全性。需要进一步评估为改进提供证据基础。
