通过“红区用药安全倡议”实施无干扰操作。
Implementing a Distraction-Free Practice With the Red Zone Medication Safety Initiative.
作者信息
Connor Jean Anne, Ahern Jeanne P, Cuccovia Barbara, Porter Courtney L, Arnold Alana, Dionne Roger E, Hickey Patricia A
机构信息
Jean Anne Connor, PhD, RN, CPNP, FAAN, is director of nursing research for Cardiovascular and Critical Care Services, Department of Nursing Patient Services, Boston Children's Hospital, and clinical instructor of pediatrics at Harvard Medical School. Jeanne P. Ahern, MHA, BSN, RN, CCRN, is staff nurse III, Cardiovascular Operating Room at Boston Children's Hospital, Massachusetts. Barbara Cuccovia, MSN, RN, CPON, is nurse manager for the Hematopoietic Stem Cell Transplant Unit of Boston Children's Hospital. Courtney L. Porter, MPH, is Program Administration Manager II for Cardiovascular and Critical Care Services, Department of Nursing Patient Services, Boston Children's Hospital. Alana Arnold, PharmD, is director of the Department of Pharmacy, Boston Children's Hospital. Roger E. Dionne, PharmD, is formulary and medication safety manager for the Department of Pharmacy, Boston Children's Hospital. Patricia A. Hickey, PhD, MBA, RN, FAAN, is vice president and associate chief nurse for Cardiovascular and Critical Care Services, Department of Nursing Patient Services, Boston Children's Hospital, and Assistant Professor of Pediatrics at Harvard Medical School.
出版信息
Dimens Crit Care Nurs. 2016 May-Jun;35(3):116-24. doi: 10.1097/DCC.0000000000000179.
BACKGROUND
The incidence of medication errors remains a continued concern across the spectrum of health care. Approaches to averting medication errors and implementing a culture of safety are key areas of focus for most institutions. We describe our experience of implementing a distraction-free medication safety practice across a large free-standing children's hospital.
METHODS
A nurse-led interprofessional group was convened to develop a program-wide quality improvement process for the practice of medication safety. A key driver diagram was developed to guide the Red Zone Medication Safety initiative. Change acceleration process was used to evaluate the implementation and impact of the initiative.
RESULTS
Since implementation in 2010, there has been a significant reduction in medication events of 79.2% (P = .00184) and 65.3% (P = .035) (in the cardiac intensive care unit and acute care cardiac unit, respectively), including months with unprecedented zero reportable medication events. There also has been a sustained decrease in the number of events reaching the patient (33.3% in the cardiac intensive care unit and 57.1% in the acute care cardiac unit).
CONCLUSIONS
The implementation of a distraction-free practice was found to be feasible and effective, demonstrating a sustained decrease in the overall number of medication events, event rate, and number of events reaching patients. This interprofessional approach was successful in a large inpatient cardiovascular program and then effectively transferred across all hospital inpatient units. Additional sites of implementation include other high-risk patient care areas such as procedure/operative units.
背景
用药错误的发生率在整个医疗保健领域仍然是一个持续令人担忧的问题。避免用药错误和营造安全文化的方法是大多数机构关注的关键领域。我们描述了在一家大型独立儿童医院实施无干扰用药安全实践的经验。
方法
召集了一个由护士领导的跨专业小组，为用药安全实践制定全院范围的质量改进流程。绘制了关键驱动因素图以指导“红色区域用药安全”倡议。采用变革加速流程来评估该倡议的实施情况和影响。
结果
自2010年实施以来，用药事件显著减少，在心脏重症监护病房和急性心脏护理病房分别减少了79.2%（P = 0.00184）和65.3%（P = 0.035），包括出现前所未有的零可报告用药事件的月份。到达患者的事件数量也持续下降（心脏重症监护病房下降33.3%，急性心脏护理病房下降57.1%）。
结论
发现实施无干扰实践是可行且有效的，表明用药事件的总数、事件发生率以及到达患者的事件数量持续下降。这种跨专业方法在一个大型住院心血管项目中取得了成功，然后有效地推广到了医院所有住院科室。其他实施地点包括其他高风险患者护理区域，如手术/操作科室。
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