Ferguson Jane, Seston Liz, Ashcroft Darren M
Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy & Optometry, School of Health Sciences, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, M13 9PL, Manchester, UK.
BMC Health Serv Res. 2018 Jun 7;18(1):424. doi: 10.1186/s12913-018-3262-z.
Transition between care settings is a time of high risk for preventable medication errors. Poor communication about medication changes on discharge from hospital can result in adverse drug events and medicines-related readmissions. Refer-to-Pharmacy is a novel electronic referral system that allows hospital pharmacy staff to refer patients from their bedside to their community pharmacist for post-hospital discharge medication support. The aim of this study was to examine factors that promoted or inhibited the implementation of Refer-to-Pharmacy in hospital and community settings.
Twenty six interviews with hospital pharmacists (n = 11), hospital technicians (n = 10), and community pharmacists (n = 5) using Normalisation Process Theory (NPT) as the underpinning conceptual framework for data collection and analysis.
Using NPT to understand the implementation of the technology revealed that the participants unanimously agreed that the scheme was potentially beneficial for patients and was more efficient than previous systems (coherence). Leadership and initiation of the scheme was more achievable in the contained hospital environment, while initiation was slower to progress in the community pharmacy settings (cognitive participation). Hospital pharmacists and technicians worked flexibly together to deliver the scheme, and community pharmacists reported better communication with General Practitioners (GPs) about changes to patients' medication (collective action). However, participants reported being unaware of how the scheme impacted patients, meaning they were unable to evaluate the effectiveness of scheme (reflexive monitoring).
The Refer-to-Pharmacy scheme was perceived by participants as having important benefits for patients, reduced the possibility for human error, and was more efficient than previous ways of working. However, initiation of the scheme was more achievable in the single site of the hospital in comparison to disparate community pharmacy organisations. Community and hospital pharmacists and organisational leaders will need to work individually and collectively if Refer-to-Pharmacy is to become more widely embedded across health settings.
医疗机构之间的过渡阶段是发生可预防用药错误的高风险时期。出院时关于用药变化的沟通不畅可能导致药物不良事件和与药物相关的再入院情况。“转介至药房”是一种新型电子转介系统，它允许医院药房工作人员在患者床边将其转介给社区药剂师，以便在出院后提供用药支持。本研究的目的是探讨在医院和社区环境中促进或阻碍“转介至药房”实施的因素。
采用归一化过程理论（NPT）作为数据收集和分析的基础概念框架，对11名医院药剂师、10名医院技术人员和5名社区药剂师进行了26次访谈。
运用NPT来理解该技术的实施情况发现，参与者一致认为该方案对患者可能有益，且比以前的系统更高效（连贯性）。在封闭的医院环境中，该方案的领导和启动更容易实现，而在社区药房环境中启动进展较慢（认知参与）。医院药剂师和技术人员灵活合作以实施该方案，社区药剂师报告称与全科医生就患者用药变化的沟通更好（集体行动）。然而，参与者表示不知道该方案对患者有何影响，这意味着他们无法评估该方案的有效性（反思性监测）。
参与者认为“转介至药房”方案对患者有重要益处，减少了人为错误的可能性，且比以前的工作方式更高效。然而，与分散的社区药房组织相比，该方案在医院的单一地点更容易启动。如果“转介至药房”要在更广泛的医疗机构中得到更深入的应用，社区和医院药剂师以及组织领导者需要单独和集体地开展工作。
