差距、陷阱、桥梁和支撑物：心力衰竭患者出院后药品管理系统中恢复力的混合方法研究。
Gaps, traps, bridges and props: a mixed-methods study of resilience in the medicines management system for patients with heart failure at hospital discharge.
机构信息
School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK.
Yorkshire Quality & Safety Research Group, Bradford Institute for Health Research, Bradford, UK.
出版信息
BMJ Open. 2019 Feb 19;9(2):e023440. doi: 10.1136/bmjopen-2018-023440.
INTRODUCTION
Poor medicines management places patients at risk, particularly during care transitions. For patients with heart failure (HF), optimal medicines management is crucial to control symptoms and prevent hospital readmission. This study explored the concept of resilience using HF as an example condition to understand how the system compensates for known and unknown weaknesses.
METHODS
We explored resilience using a mixed-methods approach in four healthcare economies in the north of England. Data from hospital site observations, healthcare staff and patient interviews, and documentary analysis were collected between June 2016 and March 2017. Data were synthesised and analysed using framework analysis.
RESULTS
Interviews were conducted with 45 healthcare professionals, with 20 patients at three time points and 189 hours of observation were undertaken. We identified four primary inter-related themes concerning organisational resilience. These were named as gaps, traps, bridges and props. Gaps were discontinuities in processes that had the potential to result in poorly optimised medicines. Traps were features of the system that could produce errors or unintended adverse medication events. Bridges were features of the medicines management system that promoted safety and continuity which ensured that, despite varying conditions, care could be delivered successfully. Props were informal, temporary or impromptu actions taken by patients or healthcare staff to avoid potential adverse events.
CONCLUSION
The numerous opportunities for HF patient safety to be compromised and for suboptimal medicines management during this common care transition are mitigated by system resilience. Cross-organisational bridges and temporary fixes or 'props' put in place by patients and carers, healthcare teams and organisations are critical for safe and optimal care to be delivered in the face of continued system pressures.
简介
药品管理不善会使患者面临风险，尤其是在医疗护理交接期间。对于心力衰竭（HF）患者，优化药物管理对于控制症状和预防住院再入院至关重要。本研究以 HF 为例，探讨了弹性的概念，以了解系统如何补偿已知和未知的弱点。
方法
我们使用混合方法在英格兰北部的四个医疗保健经济体中探索了弹性。2016 年 6 月至 2017 年 3 月期间，收集了来自医院现场观察、医疗保健人员和患者访谈以及文件分析的数据。使用框架分析对数据进行综合和分析。
结果
共对 45 名医疗保健专业人员进行了访谈，其中 20 名患者在三个时间点接受了访谈，进行了 189 小时的观察。我们确定了与组织弹性相关的四个主要主题。这些主题分别被命名为差距、陷阱、桥梁和支撑物。差距是指在潜在导致优化药物效果不佳的过程中存在的不连续性。陷阱是指系统中可能导致错误或意外药物不良事件的特征。桥梁是促进安全和连续性的药物管理系统的特征，确保尽管条件不同，仍能成功提供护理。支撑物是患者或医疗保健人员为避免潜在不良事件而采取的临时或即兴行动。
结论
HF 患者安全面临众多风险，在这种常见的医疗护理交接期间，药物管理也可能不佳，但系统的弹性减轻了这些风险。跨组织的桥梁以及患者和护理人员、医疗团队和组织临时采取的临时措施或“支撑物”对于在持续的系统压力下提供安全和优化的护理至关重要。
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