Botros Shady, Dunn John
Pharmacy, NHS Tayside, Dundee, UK.
BMJ Open Qual. 2019 Aug 1;8(3):e000363. doi: 10.1136/bmjoq-2018-000363. eCollection 2019.
Changes are often made to medications at times of transitions in care. Inadequate reconciliation during admission, transfer and discharge causes medication errors and increases risks of patient harm. Despite well-established multidisciplinary medicines reconciliation (MR) processes at hospital admission, our MR process at discharge; however, was poor. The main errors included failure to recommence withheld medicines and lack of documentation explaining changes made to medications on discharge. Our objective was to develop an intervention that supports prescribers to follow a simple standardised MR process at discharge to reduce these errors.
Working closely as a multidisciplinary team, we used improvement methodologies to design and test a process that reliably directs prescribers in surgery to use the inpatient prescribing chart as well as the MR on admission form as sources to create accurate discharge prescriptions. The project was segmented into testing, implementation, spread and sustainability.
The tested intervention helped the accuracy of discharge prescriptions steadily and quickly improve from 45% to 96% in the pilot ward. Following the successful implementation and sustainability in two separate pilot wards, the intervention was spread to the remaining eight wards producing a similar improvement.
To improve patient safety, it is crucial to ensure that information about medicines is effectively communicated when care is transferred between teams. Although this can be challenging, we've shown that it can be done effectively and reliably if this responsibility is equally shared by healthcare professionals from all disciplines while being supported by safe systems that make it easy to do the right thing. Successfully implementing a standardised multidisciplinary MR process at discharge can also reduce the reliance on pharmacists therefore freeing them to undertake other clinical roles.
在医疗护理转接期间，药物治疗方案常常会发生改变。入院、转院和出院时的药物核对不充分会导致用药错误，并增加患者受到伤害的风险。尽管在医院入院时已有完善的多学科药物核对（MR）流程，但我们出院时的MR流程却很糟糕。主要错误包括未重新开始停用的药物，以及缺乏关于出院时药物变更的记录说明。我们的目标是开发一种干预措施，支持开处方者在出院时遵循简单的标准化MR流程，以减少这些错误。
作为一个多学科团队紧密合作，我们使用改进方法来设计和测试一个流程，该流程能可靠地指导外科开处方者将住院处方表以及入院时的MR表格作为依据，以开具准确的出院处方。该项目分为测试、实施、推广和可持续性四个阶段。
经过测试的干预措施使试点病房出院处方的准确性从45%稳步快速提高到96%。在两个独立的试点病房成功实施并实现可持续性之后，该干预措施推广到了其余八个病房，也取得了类似的改善效果。
为提高患者安全，在不同团队之间进行护理转接时，确保药物信息得到有效沟通至关重要。尽管这可能具有挑战性，但我们已经表明，如果所有学科的医护人员共同承担这一责任，并得到便于正确操作的安全系统的支持，就可以有效且可靠地做到这一点。在出院时成功实施标准化的多学科MR流程还可以减少对药剂师的依赖，从而使他们能够承担其他临床角色。
