Kaestli Laure-Zoé, Cingria Laurence, Fonzo-Christe Caroline, Bonnabry Pascal
Pharmacy, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland,
Int J Clin Pharm. 2014 Oct;36(5):953-62. doi: 10.1007/s11096-014-9977-y. Epub 2014 Jul 5.
Discharging patients from hospital is a complex multidisciplinary process that can lead to non-compliance and medication-related problems.
To evaluate risks of discontinuity of pharmaceutical care at paediatric hospital discharge and assess potential improvement strategies, using two complementary methods: a prospective risk analysis and a spontaneous incident reporting system.
Geneva University hospitals and community pharmacies.
A multidisciplinary team analysed the paediatric medication discharge process applying the failure modes (FM), effects, and criticality analysis (FMECA), using ibuprofen, morphine, valganciclovir as model drugs. Over 46 months, incidents with discharge prescriptions, reported by community pharmacists, were classified according to FMECA's FM.
FM, criticality indexes (CI), incidents.
Twenty-four FM were identified. The highest criticality scores were given for prescribing the wrong dosage [mean criticality index (CI = 205)], early treatment discontinuation by the patient (CI = 195), and continuation of contraindicated treatment by the general practitioner (CI = 191). Implementation of eight improvement strategies covering the eight most critical FM led to a 64 % reduction in criticality scores (CI 496 vs 1,392). Improvement of the computerized-physician-order-entry system was the single most effective strategy (CI 843 vs 1,392). Only 52 incidents were spontaneously reported (17 for paediatric patients). Paediatric problems most frequently reported (lack of information, 35 %; delay in drug supply, 18 %) were consistent with the highest frequencies scored by FMECA.
Spontaneous incident reporting leads to high levels of under-reporting, but highlighted similar problems at paediatric hospital discharge to FMECA. Using FMECA allowed estimations of criticalities at each step and the potential impact of safety improvement strategies. Proactive and reactive methods proved complementary and would help to set up effective targeted improvement strategies to improve medication process at paediatric hospital discharge.
患者出院是一个复杂的多学科过程，可能导致不依从和药物相关问题。
采用两种互补方法，即前瞻性风险分析和自发事件报告系统，评估儿科医院出院时药学服务中断的风险，并评估潜在的改进策略。
日内瓦大学医院和社区药房。
一个多学科团队应用失效模式（FM）、效应及关键性分析（FMECA）对儿科药物出院流程进行分析，以布洛芬、吗啡、缬更昔洛韦作为模型药物。在46个月的时间里，社区药剂师报告的出院处方事件按照FMECA的FM进行分类。
FM、关键性指数（CI）、事件。
识别出24种FM。错误剂量处方（平均关键性指数[CI = 205]）、患者过早停药（CI = 195）以及全科医生继续使用禁忌治疗（CI = 191）的关键性得分最高。针对八个最关键的FM实施八项改进策略，使关键性得分降低了64%（CI从496降至1392）。改进计算机化医生医嘱录入系统是最有效的单一策略（CI从843降至1392）。仅自发报告了52起事件（儿科患者17起）。最常报告的儿科问题（信息缺失，35%；药物供应延迟，18%）与FMECA得分最高的频率一致。
自发事件报告导致报告严重不足，但凸显了与FMECA在儿科医院出院时类似的问题。使用FMECA能够估计每个步骤的关键性以及安全改进策略的潜在影响。主动和被动方法证明具有互补性，有助于制定有效的针对性改进策略，以改善儿科医院出院时的用药流程。
