Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Sydney, Australia.
Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Appl Clin Inform. 2020 Oct;11(5):812-820. doi: 10.1055/s-0040-1721011. Epub 2020 Dec 9.
Transdermal medication patches have caused serious adverse events in residential aged care facilities (RACFs). Preliminary research suggests that facilities are using a workaround consisting of manually entered reminders in their electronic medication administration records (eMARs) to prompt staff to check and remove patches, because the eMAR does not support these tasks. However, the prevalence and factors associated with use of this workaround among facilities is unknown.
The objectives of this study were to (1) examine the frequency and consistency with which manual reminders to check and remove transdermal patches were used in facility eMARs, and (2) identify resident and facility factors associated with reminder use, to inform eMAR redesign.
This was a retrospective cross-sectional analysis of eMAR data from 66 Australian RACFs including 4,787 permanent residents, aged ≥65 years in January 2017. Prevalence of the use of reminders to check and remove patches, and consistency in their application within facilities were examined. Generalized estimating equations were used to determine factors associated with use of manual reminders.
One in five ( = 937) residents used a patch, and 83.6% of patches contained opioids, a high-risk medicine. 56.9% of facilities implemented manually entered check patch reminders in the eMAR, and 72.3% implemented remove reminders. The reminders were applied inconsistently, with only half of these facilities having reminders for all residents with patches. Residents in facilities in regional areas were more likely to have a check reminder compared with those in major cities (adjusted odds ratio = 4.72 [95% confidence interval: 1.69-13.20]).
Transdermal patches containing high-risk medicines are frequently used in RACFs, but their safe administration is not supported by a widely implemented eMAR. The frequent, but inconsistent use of a workaround to manually enter reminders indicates an unmet need for new eMAR functionality to improve safety.
经皮给药贴片在养老院（RACFs）中已引发严重不良事件。初步研究表明，各机构采用了一种变通方法，即在电子医嘱记录系统（eMAR）中手动输入提醒以提示工作人员检查并移除贴片，因为 eMAR 不支持这些任务。但是，尚不清楚各机构使用此变通方法的频率及其相关因素。
本研究的目的是：（1）检查在机构的 eMAR 中手动检查和移除经皮贴片的提醒的使用频率和一致性；（2）确定与提醒使用相关的居民和机构因素，为 eMAR 重新设计提供信息。
这是一项对 2017 年 1 月 66 家澳大利亚 RACFs 的 eMAR 数据进行的回顾性横断面分析，共纳入 4787 名年龄≥65 岁的常住居民。检查了检查和移除贴片的提醒的使用情况及其在机构内的应用一致性。使用广义估计方程确定与使用手动提醒相关的因素。
五分之一（=937）的居民使用了贴片，其中 83.6%的贴片含有阿片类药物，属于高风险药物。56.9%的机构在 eMAR 中实施了手动输入检查贴片的提醒，72.3%的机构实施了移除提醒。这些提醒的应用不一致，只有一半的机构对所有使用贴片的居民都设置了提醒。与位于主要城市的机构相比，位于地区的机构中居民更有可能设置检查提醒（调整后的优势比=4.72 [95%置信区间：1.69-13.20]）。
含有高风险药物的经皮贴片在 RACFs 中广泛使用，但广泛实施的 eMAR 并不支持其安全管理。频繁但不一致地使用手动输入提醒的变通方法表明，需要新的 eMAR 功能来提高安全性。
