Department of Pharmacy Services, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA.
Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA.
Am J Health Syst Pharm. 2022 May 24;79(Suppl 2):S53-S64. doi: 10.1093/ajhp/zxab383.
The American Society of Health-System Pharmacists (ASHP) and Pediatric Pharmacy Advocacy Group (PPAG) guidelines for providing pediatric pharmacy services in hospitals and health systems can be used to improve medication safety wherever pediatric patients receive care, including in the emergency department (ED). The purpose of this initiative was to improve compliance with these guidelines in a primarily adult ED.
This quality improvement initiative was conducted in a level 1 trauma center ED between October 2019 and March 2020. The ASHP-PPAG guidelines were used to create practice elements applicable to the ED. An initial compliance assessment defined elements as noncompliant, partially compliant, fully compliant, or not applicable. Investigators identified interventions to improve compliance for noncompliant or partially compliant elements and then reassessed compliance following implementation. Data were expressed using descriptive statistics. This initiative was exempt from institutional review board approval.
Ninety-three ED practice elements were identified within the 9 standards of the ASHP-PPAG guidelines. At the initial compliance assessment, the majority (59.8%) of practice elements were fully compliant; however, various service gaps were identified in 8 of the standards, and 16 interventions were implemented to improve compliance. At the final compliance assessment, there was a 19.5% increase in full compliance. Barriers to achieving full compliance included technology restrictions, time constraints, financial limitations, and influences external to pharmacy.
This quality improvement initiative demonstrated that the ASHP-PPAG guidelines can be used to improve ED pediatric pharmacy services in a primarily adult institution. The initiative may serve as an example for other hospitals to improve compliance with the guidelines.
美国卫生系统药剂师学会（ASHP）和儿科药剂师倡导小组（PPAG）制定的在医院和医疗系统中提供儿科药学服务的指南可用于提高儿科患者接受治疗的任何场所（包括急诊科[ED]）的用药安全性。本倡议旨在提高主要成人 ED 对这些指南的遵循率。
本质量改进倡议于 2019 年 10 月至 2020 年 3 月在 1 级创伤中心 ED 进行。ASHP-PPAG 指南用于创建适用于 ED 的实践要素。初始合规性评估将要素定义为不遵守、部分遵守、完全遵守或不适用。调查人员确定了提高不遵守或部分遵守要素的合规性的干预措施，然后在实施后重新评估合规性。数据采用描述性统计方法表示。该倡议免于机构审查委员会的批准。
在 ASHP-PPAG 指南的 9 项标准中，确定了 93 项 ED 实践要素。在初始合规性评估中，大多数（59.8%）实践要素完全遵守；然而，在 8 项标准中发现了各种服务差距，并实施了 16 项干预措施以提高合规性。在最终合规性评估中，完全遵守的比例增加了 19.5%。实现完全遵守的障碍包括技术限制、时间限制、财务限制以及药剂科以外的因素的影响。
本质量改进倡议表明，ASHP-PPAG 指南可用于提高主要为成人机构的 ED 儿科药学服务水平。该倡议可作为其他医院提高指南遵循率的范例。
