利用健康信息技术应用安全科学原则提高围产期患者安全
Advancing perinatal patient safety through application of safety science principles using health IT.
机构信息
RTI International, 3040 E. Cornwallis Rd, Research Triangle Park, NC, 27709, USA.
University of Minnesota School of Nursing, 5-140 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN, 55455, USA.
出版信息
BMC Med Inform Decis Mak. 2017 Dec 19;17(1):176. doi: 10.1186/s12911-017-0572-8.
BACKGROUND
The use of health information technology (IT) has been shown to promote patient safety in Labor and Delivery (L&D) units. The use of health IT to apply safety science principles (e.g., standardization) to L&D unit processes may further advance perinatal safety.
METHODS
Semi-structured interviews were conducted with L&D units participating in the Agency for Healthcare Research and Quality's (AHRQ's) Safety Program for Perinatal Care (SPPC) to assess units' experience with program implementation. Analysis of interview transcripts was used to characterize the process and experience of using health IT for applying safety science principles to L&D unit processes.
RESULTS
Forty-six L&D units from 10 states completed participation in SPPC program implementation; thirty-two (70%) reported the use of health IT as an enabling strategy for their local implementation. Health IT was used to improve standardization of processes, use of independent checks, and to facilitate learning from defects. L&D units standardized care processes through use of electronic health record (EHR)-based order sets and use of smart pumps and other technology to improve medication safety. Units also standardized EHR documentation, particularly related to electronic fetal monitoring (EFM) and shoulder dystocia. Cognitive aids and tools were integrated into EHR and care workflows to create independent checks such as checklists, risk assessments, and communication handoff tools. Units also used data from EHRs to monitor processes of care to learn from defects. Units experienced several challenges incorporating health IT, including obtaining organization approval, working with their busy IT departments, and retrieving standardized data from health IT systems.
CONCLUSIONS
Use of health IT played an integral part in the planning and implementation of SPPC for participating L&D units. Use of health IT is an encouraging approach for incorporating safety science principles into care to improve perinatal safety and should be incorporated into materials to facilitate the implementation of perinatal safety initiatives.
背景
健康信息技术（IT）的使用已被证明可以提高分娩单位的患者安全性。将安全科学原理（例如标准化）应用于分娩单位流程的健康 IT 的使用可能会进一步促进围产期安全。
方法
对参与美国医疗机构评审联合委员会（AHRQ）围产期护理安全计划（SPPC）的分娩单位进行了半结构化访谈，以评估单位在计划实施方面的经验。对访谈记录的分析用于描述将健康 IT 用于将安全科学原理应用于分娩单位流程的过程和经验。
结果
来自 10 个州的 46 个分娩单位完成了 SPPC 计划实施的参与；其中 32 个（70%）报告说使用健康 IT 是其本地实施的一项可行策略。健康 IT 用于改善流程的标准化、独立检查的使用以及从缺陷中学习。分娩单位通过使用基于电子健康记录（EHR）的医嘱集和使用智能泵和其他技术来改善用药安全来标准化护理流程。单位还标准化了 EHR 文档，特别是与电子胎儿监护（EFM）和肩难产有关的文档。认知辅助工具和工具被集成到 EHR 和护理工作流程中，以创建独立检查，如检查表、风险评估和沟通交接工具。单位还使用 EHR 中的数据来监测护理过程，以从缺陷中学习。单位在整合健康 IT 方面遇到了一些挑战，包括获得组织批准、与忙碌的 IT 部门合作以及从健康 IT 系统中检索标准化数据。
结论
健康 IT 的使用是参与分娩单位 SPPC 计划规划和实施的一个组成部分。健康 IT 的使用是将安全科学原理纳入护理以提高围产期安全性的一种令人鼓舞的方法，应纳入材料中以促进围产期安全计划的实施。
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