Centre of Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
Centre of Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia.
BMJ Qual Saf. 2016 Sep;25(9):704-15. doi: 10.1136/bmjqs-2015-004589. Epub 2015 Oct 14.
To identify system-related risk factors perceived to contribute to prescribing errors in Australian long-term care settings, that is, residential aged care facilities (RACFs).
The study used qualitative methods to explore factors that contribute to unsafe prescribing in RACFs. Data were collected at three RACFs in metropolitan Sydney, Australia between May and November 2011. Participants included RACF managers, doctors, pharmacists and RACF staff actively involved in prescribing-related processes. Methods included non-participant observations (74 h), in-depth semistructured interviews (n=25) and artefact analysis. Detailed process activity models were developed for observed prescribing episodes supplemented by triangulated analysis using content analysis methods.
System-related factors perceived to increase the risk of prescribing errors in RACFs were classified into three overarching themes: communication systems, team coordination and staff management. Factors associated with communication systems included limited point-of-care access to information, inadequate handovers, information storage across different media (paper, electronic and memory), poor legibility of charts, information double handling, multiple faxing of medication charts and reliance on manual chart reviews. Team factors included lack of established lines of responsibility, inadequate team communication and limited participation of doctors in multidisciplinary initiatives like medication advisory committee meetings. Factors related to staff management and workload included doctors' time constraints and their accessibility, lack of trained RACF staff and high RACF staff turnover.
The study highlights several system-related factors including laborious methods for exchanging medication information, which often act together to contribute to prescribing errors. Multiple interventions (eg, technology systems, team communication protocols) are required to support the collaborative nature of RACF prescribing.
确定澳大利亚长期护理机构（即养老院）中被认为导致处方错误的与系统相关的风险因素。
本研究采用定性方法探讨导致养老院不安全处方的因素。数据于 2011 年 5 月至 11 月在澳大利亚悉尼大都市的三家养老院收集。参与者包括养老院经理、医生、药剂师和积极参与处方相关流程的养老院工作人员。方法包括非参与性观察（74 小时）、深入半结构化访谈（n=25）和人工制品分析。对观察到的处方事件进行了详细的过程活动模型开发，并结合使用内容分析方法进行三角分析。
被认为增加养老院处方错误风险的与系统相关的因素分为三个总体主题：沟通系统、团队协调和员工管理。与沟通系统相关的因素包括有限的即时访问信息、交接不足、信息存储在不同的媒体（纸质、电子和记忆）、图表可读性差、信息双重处理、多次传真药物图表以及依赖手动图表审查。团队因素包括缺乏明确的责任线、团队沟通不足以及医生在多学科倡议（如药物咨询委员会会议）中的参与有限。与员工管理和工作量相关的因素包括医生的时间限制和可及性、缺乏受过培训的养老院工作人员以及高养老院员工流动率。
该研究强调了几个与系统相关的因素，包括交换药物信息的繁琐方法，这些因素通常共同导致处方错误。需要采取多种干预措施（例如技术系统、团队沟通协议）来支持养老院处方的协作性质。
