Gabe Marie E, Jordan Sue E
Research Capacity Building Collaboration (RCBC) Wales, Swansea University, Swansea, UK.
J Nurs Manag. 2014 Apr;22(3):331-49. doi: 10.1111/jonm.12067. Epub 2013 May 23.
This paper reports on the development of an instrument for nurse-led medication monitoring, the West Wales Adverse Drug Reaction profile for respiratory medicines, as part of a strategy to reduce avoidable adverse drug reactions.
Preventable adverse drug reactions account for 3.7% hospital admissions. Nurse-led medication monitoring may reduce drug-related harm. However, development of medication monitoring strategies is not reported elsewhere.
The profile was developed by: (1) cognitive interviews (n = 4), (2) the content validity index (n = 10) involving academics, clinicians and service users prescribed respiratory medicines, (3) inter-rater reliability (n = 48) and clinical gains in a nurse-led outpatient clinic.
Cognitive interviews prompted more profile changes than either the content validity index or inter-rater reliability testing. Cohen's κ for inter-rater reliability for each item ranged from 0.73-1.00 (good to complete agreement). The profile identified previously unsuspected problems in all participants, including muscular weakness, skin and mouth problems.
The West Wales Adverse Drug Reaction profile was valid and reliable, and helped to detect and ameliorate drug-related harm.
The West Wales Adverse Drug Reaction profile offers opportunities to improve care. Medication monitoring provides the structure to concurrently monitor known adverse drug reactions. Practice-based adverse drug reaction profiles benefit from cognitive, content validity and inter-rater reliability testing.
本文报告了一种由护士主导的药物监测工具——西威尔士呼吸系统药物不良反应概况的开发情况，这是减少可避免药物不良反应策略的一部分。
可预防的药物不良反应占住院病例的3.7%。由护士主导的药物监测可能会减少药物相关伤害。然而，其他地方尚未报道药物监测策略的开发情况。
该概况的开发过程如下：（1）认知访谈（n = 4）；（2）内容效度指数（n = 10），涉及开具呼吸系统药物的学者、临床医生和服务使用者；（3）评分者间信度（n = 48）以及在护士主导的门诊诊所中的临床获益情况。
认知访谈促使概况发生的变化比内容效度指数或评分者间信度测试更多。各项目评分者间信度的Cohen's κ系数范围为0.73 - 1.00（从良好到完全一致）。该概况在所有参与者中都识别出了先前未被怀疑的问题，包括肌肉无力、皮肤和口腔问题。
西威尔士药物不良反应概况有效且可靠，有助于检测和改善药物相关伤害。
西威尔士药物不良反应概况为改善护理提供了机会。药物监测为同时监测已知的药物不良反应提供了架构。基于实践的药物不良反应概况受益于认知、内容效度和评分者间信度测试。
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