Department of Women & Children's Health, King's College London, London, UK; Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK; Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK.
Res Social Adm Pharm. 2020 Dec;16(12):1768-1774. doi: 10.1016/j.sapharm.2020.01.016. Epub 2020 Feb 6.
Children are frequently prescribed unlicensed and off-label medicines meaning dosing and administration of medicines to children is often based on poor quality guidance. In UK hospitals, nursing staff are often responsible for administering medications. Medication Errors [MEs] are problematic for health services, though are poorly reported and therefore difficult to quantify with confidence. In the UK, children's medicines require administration by at least two members of ward staff, known as a 'second check' system, thought to reduce Medication Administration Errors [MAEs].
To assess the impact on working practices of the introduction of a new way of working, using Technician Enhanced Administration of Medications [TEAM] on two specialist wards within a children's' hospital. To evidence any potential impact of a TEAM ward-based pharmacy technician [PhT] on the reporting of MEs.
A TEAM PhT was employed on two wards within the children's hospital and trained in medicines administration. Firstly, an observational pre-and-post cohort design was used to identify the effect of TEAM on MEs. We analysed the hospital's official reporting system for incidents and 'near misses', as well as the personal incident log of the TEAM PhT. Secondly, after implementation, we interviewed staff about their perceptions of TEAM and its impact on working practices.
We affirm MEs are considerably under-reported in hospital settings, but TEAM PhTs can readily identify them. Further, placing TEAM PhTs on wards may create opportunities for inter-professional knowledge exchange and increase nurses' awareness of potential MAEs, although this requires facilitation.
TEAM PhT roles may be beneficial for pharmacy technicians' motivation, job satisfaction, and career development. Hospitals will need to consider the balance between resources invested in TEAM PhTs and the level of impact on reporting MEs. Health economic analyses could provide evidence to fully endorse integration of TEAM PhTs for all hospital settings.
儿童经常服用未经许可和未经批准的药品，这意味着儿童用药的剂量和管理通常基于质量较差的指导。在英国医院，护理人员通常负责给药。用药错误[MEs]对卫生服务来说是个问题，但报告不足，因此难以有信心地进行定量。在英国，儿童药物的管理需要至少两名病房工作人员进行，称为“二次检查”系统，被认为可以减少给药错误[MAEs]。
评估在儿童医院的两个专科病房引入一种新的工作方式——技术员增强药物管理[TEAM]对工作实践的影响。证明药剂师技术员[PhT]在病房工作的 TEAM 对 ME 报告的任何潜在影响。
在儿童医院的两个病房中雇用了一名 TEAM PhT，并对其进行了药物管理培训。首先，采用观察性前后队列设计来确定 TEAM 对 ME 的影响。我们分析了医院官方的报告系统中的事件和“险些发生的事件”，以及 TEAM PhT 的个人事件日志。其次，在实施后，我们采访了工作人员，了解他们对 TEAM 的看法以及其对工作实践的影响。
我们确认医院环境中的 ME 报告严重不足，但 TEAM PhT 可以轻易识别。此外，在病房中安置 TEAM PhT 可能为专业间的知识交流创造机会，并提高护士对潜在 MAEs 的认识，尽管这需要加以促进。
TEAM PhT 角色可能对药剂师技术员的动机、工作满意度和职业发展有益。医院将需要考虑在 TEAM PhT 上投入的资源与对 ME 报告的影响程度之间的平衡。健康经济分析可以提供证据，充分支持所有医院环境中整合 TEAM PhT。
