Steele Maria L, Talley Brenda, Frith Karen H
College of Nursing, The University of Alabama in Huntsville, AL, United States.
College of Nursing, The University of Alabama in Huntsville, AL, United States.
Arch Psychiatr Nurs. 2018 Feb;32(1):7-11. doi: 10.1016/j.apnu.2017.09.005. Epub 2017 Sep 5.
Medication safety and error reduction has been studied in acute and long-term care settings, but little research is found in the literature regarding mental health settings. Because mental health settings are complex, medication administration is vulnerable to a variety of errors from transcription to administration. The purpose of this study was to analyze critical factors related to a mental health work system structure and processes that threaten safe medication administration practices.
The Systems Engineering Initiative for Patient Safety (SEIPS) model provides a framework to analyze factors affecting medication safety. The model approach analyzes the work system concepts of technology, tasks, persons, environment, and organization to guide the collection of data.
In the study, the Lean methodology tools were used to identify vulnerabilities in the system that could be targeted later for improvement activities. The project director completed face-to-face interviews, asked nurses to record disruptions in a log, and administered a questionnaire to nursing staff. The project director also conducted medication chart reviews and recorded medication errors using a standardized taxonomy for errors that allowed categorization of the prevalent types of medication errors.
Results of the study revealed disruptions during the medication process, pharmacology training needs, and documentation processes as the primary opportunities for improvement. The project engaged nurses to identify sustainable quality improvement strategies to improve patient safety.
The mental health setting carries challenges for safe medication administration practices. Through analysis of the structure, process, and outcomes of medication administration, opportunities for quality improvement and sustainable interventions were identified, including minimizing the number of distractions during medication administration, training nurses on psychotropic medications, and improving the documentation system. A task force was created to analyze the descriptive data and to establish objectives aimed at improving efficiency of the work system and care process involved in medication administration at the end of the project.
药物安全及减少用药错误已在急性和长期护理环境中得到研究，但文献中关于心理健康环境的研究较少。由于心理健康环境复杂，从转录到给药的药物管理容易出现各种错误。本研究的目的是分析与威胁安全用药实践的心理健康工作系统结构和流程相关的关键因素。
患者安全系统工程倡议（SEIPS）模型提供了一个分析影响药物安全因素的框架。该模型方法分析技术、任务、人员、环境和组织等工作系统概念，以指导数据收集。
在本研究中，采用精益方法工具来识别系统中的漏洞，这些漏洞随后可作为改进活动的目标。项目负责人完成面对面访谈，要求护士在日志中记录干扰情况，并向护理人员发放问卷。项目负责人还进行了用药图表审查，并使用标准化的错误分类法记录用药错误，该分类法允许对常见类型的用药错误进行分类。
研究结果表明，用药过程中的干扰、药理学培训需求和文件记录流程是主要的改进机会。该项目促使护士确定可持续的质量改进策略，以提高患者安全。
心理健康环境给安全用药实践带来了挑战。通过对用药管理的结构、流程和结果进行分析，确定了质量改进和可持续干预的机会，包括尽量减少用药过程中的干扰、对护士进行精神药物培训以及改进文件记录系统。在项目结束时，成立了一个特别工作组来分析描述性数据，并制定旨在提高用药管理工作系统和护理流程效率的目标。
