Stephen Gigimol, Moran Dane, Broderick Joan, Shaikh Hanan A, Tschudy Megan M, Connors Cheryl, Williams Tammy, Pham Julius C
Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, Md.; Johns Hopkins University School of Medicine, Baltimore, Md.; and University of Hawaii School of Medicine, Honolulu, Hawaii.
Pediatr Qual Saf. 2017 Apr 17;2(3):e021. doi: 10.1097/pq9.0000000000000021. eCollection 2017 May-Jun.
The delivery of urgent ("stat") medications to hospitalized children is important for safe quality care. The goal of this study was to evaluate the effect of a set of interventions on the percentage of stat medications administered within 30 minutes of ordering.
A pre-post study in 2 pediatric units (36 beds) in a private hospital in Saudi Arabia between January 2015 and September 2016. Interventions included structured communication requirements, introduction of a dedicated electronic inbox for stat medication orders sent by nurses to the pharmacy, and the use of a pink envelope for the delivery of stat medications. A multivariate logistic regression model was used to model percentage of medications administered within goal.
Three hundred four stat orders met inclusion criteria. The proportion of orders meeting the 30-minute goal increased from a mean of 20% to a mean of 49% after the interventions ( < 0.001). In the final month of the study, compliance reached a peak of 67%. The mean turnaround time from ordering to the administration of the medication decreased from 59.7 to 40.7 minutes ( < 0.001). On multivariate analysis, medication type and unit-based availability of medications were statistically significant predictors of turnaround time. The odds of compliance being achieved was 0.3 times less if the medication was not available on the unit.
A set of interventions significantly increased the percentage of stat medications delivered within 30 minutes.
向住院儿童提供紧急（“即刻”）用药对于安全优质护理至关重要。本研究的目的是评估一系列干预措施对医嘱开出后30分钟内即刻用药给药百分比的影响。
2015年1月至2016年9月在沙特阿拉伯一家私立医院的2个儿科病房（36张床位）进行的一项前后对照研究。干预措施包括结构化沟通要求、引入护士发送给药房的即刻用药医嘱专用电子收件箱，以及使用粉色信封递送即刻用药。使用多元逻辑回归模型对目标时间内给药的药物百分比进行建模。
304条即刻用药医嘱符合纳入标准。干预后，达到30分钟目标的医嘱比例从平均20%提高到了平均49%（<0.001）。在研究的最后一个月，依从率达到了67%的峰值。从医嘱开出到药物给药的平均周转时间从59.7分钟降至40.7分钟（<0.001）。在多变量分析中，药物类型和病房内药物的可获得性是周转时间的统计学显著预测因素。如果病房内没有该药物，达到依从性的几率会降低0.3倍。
一系列干预措施显著提高了30分钟内递送的即刻用药百分比。
