Burkoski Vanessa, Yoon Jennifer, Solomon Shirley, Hall Trevor N T, Karas Albert B, Jarrett Scott R, Collins Barbara E
Chief Nursing Executive & Chief, People Strategy, Humber River Hospital, Toronto, ON.
Senior Director, Professional Practice, Quality & Patient Safety Humber River Hospital, Toronto, ON.
Nurs Leadersh (Tor Ont). 2019 May;32(SP):16-28. doi: 10.12927/cjnl.2019.25817.
Healthcare organizations have long been dependent on the vigilance of nurses to identify and intercept medication errors before they can adversely affect patients. New technologies have been implemented in an effort to reduce medication errors; however, few studies have evaluated the long-term effects of technology-based interventions in reducing medication errors.
The aim of this study was to evaluate the effects of barcode medication administration (BCMA) and the closed-loop medication system (CLMS) interventions on medication errors and adverse drug event (ADE) rates.
An autoregressive integrated moving average model for interrupted time series design was used to evaluate the impact of the BCMA and CLMS interventions on the monthly reported medication error and ADE rates at Humber River Hospital between September 2013 and August 2018. Descriptive statistics were generated to evaluate the types of error and their gravity.
A total of 1,712 medication errors and ADEs were reported in the five-year study period. The results of the interrupted time series indicated that the introduction of the BCMA intervention was associated with a statistically significant gradual decrease in reported medication error and ADE rates at 0.002 percentage points per month (p = 0.003). The introduction of the CLMS intervention was associated with an immediate absolute decrease in reported medication error and ADE rates of 0.010% (p = 0.020).
The findings from this study support the adoption of both BCMA and CLMS interventions to prevent medication errors. Staged implementation of CLMS allows time for learning and incorporating barcode scanning. Interprofessional and cross-functional collaboration is necessary to successfully integrate the requirements of each respective discipline and service in the CLMS.
长期以来，医疗保健机构一直依赖护士的警觉性来识别并拦截可能对患者产生不利影响的用药错误。为减少用药错误，已采用了新技术；然而，很少有研究评估基于技术的干预措施在减少用药错误方面的长期效果。
本研究旨在评估条形码给药（BCMA）和闭环给药系统（CLMS）干预措施对用药错误和药物不良事件（ADE）发生率的影响。
采用自回归积分滑动平均模型进行中断时间序列设计，以评估2013年9月至2018年8月期间BCMA和CLMS干预措施对洪伯河医院每月报告的用药错误和ADE发生率的影响。生成描述性统计数据以评估错误类型及其严重程度。
在为期五年的研究期间，共报告了1712例用药错误和ADE。中断时间序列的结果表明，BCMA干预措施的引入与报告的用药错误和ADE发生率每月以0.002个百分点的幅度在统计学上显著逐渐下降相关（p = 0.003）。CLMS干预措施的引入与报告的用药错误和ADE发生率立即绝对下降0.010%相关（p = 0.020）。
本研究结果支持采用BCMA和CLMS干预措施来预防用药错误。CLMS的分阶段实施为学习和纳入条形码扫描留出了时间。跨专业和跨职能协作对于在CLMS中成功整合各学科和服务的要求至关重要。
