Philips Kaitlyn, Zhou Roy, Lee Diana S, Marrese Christine, Nazif Joanne, Browne Constance, Sinnett Mark, Tuckman Steven, Modi Anjali, Rinke Michael L
Children's Hospital at Montefiore, Bronx, New York;
Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York.
Pediatrics. 2021 Feb;147(2). doi: 10.1542/peds.2019-2711. Epub 2021 Jan 6.
The pediatric inpatient discharge medication process is complicated, and caregivers have difficulty managing instructions. Authors of few studies evaluate systematic processes for ensuring quality in these care transitions. We aimed to improve caregiver medication management and understanding of discharge medications by standardizing the discharge medication process.
An interprofessional team at an urban, tertiary care children's hospital trialed interventions to improve caregiver medication management and understanding. These included mnemonics to aid in complete medication counseling, electronic medical record enhancements to standardize medication documentation and simplify dose rounding, and housestaff education. The primary outcome measure was the proportion of discharge medication-related failures in each 4-week period. Failure was defined as an incorrect response on ≥1 survey questions. Statistical process control was used to analyze improvement over time. Process measures related to medication documentation and dose rounding were compared by using the χ test and process control.
Special cause variation occurred in the mean discharge medication-related failure rate, which decreased from 70.1% to 36.1% and was sustained. There were significantly more complete after-visit summaries (21.0% vs 85.1%; < .001) and more patients with simplified dosing (75.2% vs 95.6%; < .001) in the intervention period. Special cause variation also occurred for these measures.
A systematic approach to standardizing the discharge medication process led to improved caregiver medication management and understanding after pediatric inpatient discharge. These changes could be adapted by other hospitals to enhance the quality of this care transition.
儿科住院患者出院用药流程复杂，护理人员在执行医嘱时存在困难。很少有研究的作者评估确保这些护理转接质量的系统流程。我们旨在通过规范出院用药流程来改善护理人员的用药管理及对出院用药的理解。
一家城市三级儿童医院的跨专业团队试验了多种干预措施，以改善护理人员的用药管理及理解。这些措施包括帮助进行完整用药咨询的记忆法、增强电子病历以规范用药记录并简化剂量取整，以及对住院医师的教育。主要结局指标是每4周内出院用药相关失误的比例。失误定义为在≥1个调查问题上回答错误。采用统计过程控制来分析随时间的改善情况。通过χ检验和过程控制对与用药记录和剂量取整相关的过程指标进行比较。
出院用药相关失误率均值出现特殊原因变异，该均值从70.1%降至36.1%并得以维持。在干预期间，访后总结更完整的情况显著增多（21.0%对85.1%；P<0.001），剂量简化的患者也显著增多（75.2%对95.6%；P<0.001）。这些指标也出现了特殊原因变异。
一种规范出院用药流程的系统方法可改善儿科住院患者出院后护理人员的用药管理及理解。其他医院可采用这些改变来提高这种护理转接的质量。
