无错法是否能提高出院带药指导和遵从性？
Do Errorless Methods Improve Discharge Medication Instruction and Adherence?
机构信息
Center for Rehabilitation Medicine, Dignity Health-Northridge Hospital Medical Center, Northridge, CA, USA.
California State University, Northridge, Northridge, CA, USA.
出版信息
Rehabil Nurs. 2020 Dec 1;45(6):358-366. doi: 10.1097/rnj.0000000000000237.
PURPOSE AND DESIGN
Postdischarge adverse drug events are a national issue, and effective inpatient instruction may help. Therefore, this intervention study examined whether using errorless teaching/learning methods including pictorial medication cards (ETL + card) improved RN teaching and patient medication adherence among persons with cognitive challenges (PWCCs).
METHODS
Convenience samples of RNs and PWCCs from a 24-bed rehabilitation unit provided baseline data. RNs implemented ETL + card, and postintervention data were collected. Adapted and investigator-designed instruments had preliminary reliability/validity.
FINDINGS
Postintervention RNs demonstrated more teaching strategies (p = .003), and teaching satisfaction rose from 0% to 50%. Minutes per teaching interaction were unchanged (p > .05). Baseline patients filled a higher number (p = .02) but a lower percentage (67%) of their prescriptions than did postintervention patients (85%). Medication dose adherence scores were unchanged (p > .05).
CONCLUSIONS
ETL + card improved RN teaching and possibly patient adherence. Further study is warranted.
CLINICAL RELEVANCE
ETL + card may help PWCCs achieve safe medication self-management.
目的与设计
出院后药物不良反应是一个全国性问题，有效的住院期间指导可能会有所帮助。因此，这项干预研究检验了使用无错误教学/学习方法（包括用药图片卡）是否可以提高有认知障碍的患者（PWCC）的 RN 教学和患者用药依从性。
方法
从一个 24 张病床的康复病房中选取 RN 和 PWCC 作为方便样本，提供基线数据。RN 实施无错误教学/学习方法（ETL + 卡），并收集干预后的数据。经改编和研究者设计的工具具有初步的可靠性/有效性。
发现
干预后，RN 表现出更多的教学策略（p =.003），教学满意度从 0%上升到 50%。每次教学互动的时间保持不变（p >.05）。基线患者填写的处方数量更多（p =.02），但完成的比例更低（67%），而干预后患者完成的比例更高（85%）。用药剂量依从性评分保持不变（p >.05）。
结论
ETL + 卡提高了 RN 的教学效果，可能提高了患者的依从性。需要进一步研究。
临床相关性
ETL + 卡可能有助于 PWCC 实现安全的药物自我管理。
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