养老院安全用药质量标准：通过包括德尔菲共识研究在内的多步骤方法制定。
Quality standards for safe medication in nursing homes: development through a multistep approach including a Delphi consensus study.
机构信息
Swiss Patient Safety Foundation, Zurich, Switzerland
Swiss Patient Safety Foundation, Zurich, Switzerland.
出版信息
BMJ Open. 2021 Oct 11;11(10):e054364. doi: 10.1136/bmjopen-2021-054364.
OBJECTIVES
The aim of the study was to develop quality standards reflecting minimal requirements for safe medication processes in nursing homes.
DESIGN
In a first step, relevant key topics for safe medication processes were deducted from a systematic search for similar guidelines, prior work and discussions with experts. In a second step, the essential requirements for each key topic were specified and substantiated with a literature-based rationale. Subsequently, the requirements were evaluated with a piloted, two-round Delphi study.
SETTING
Nursing homes in Switzerland.
PARTICIPANTS
Interprofessional panel of 25 experts from science and practice.
PRIMARY AND SECONDARY OUTCOME MEASURES
Each requirement was rated for its relevance for a safer and resident-oriented medication on a 9-point Likert-Scale based on the RAND/UCLA method. The requirements were considered relevant if, in the second round, the median relevance rating was ≥7 and the proportion of ratings ≥7 was ≥80%.
RESULTS
Five key topics with a total of 87 requirements were elaborated and rated in the Delphi study. After the second round (response rate in both rounds 100%), 85 requirements fulfilled the predefined criteria and were therefore included in the final set of quality standards. The five key topics are: (I) 'The medication is reviewed regularly and in defined situations', (II) 'The medication is reviewed in a structured manner', (III) 'The medication is monitored in a structured manner', (IV) 'All healthcare professionals are committed to an optimal interprofessional collaboration' and (V) 'Residents are actively involved in medication process'.
CONCLUSIONS
We developed normative quality standards for a safer and resident-oriented medication in Swiss nursing homes. Altogether, 85 requirements define the medication processes and the behaviour of healthcare professionals. A rigorous implementation may support nursing homes in taking a step towards safer and resident-oriented medication.
目的
本研究旨在制定反映养老院安全用药流程最低要求的质量标准。
设计
在第一步中，从针对类似指南、先前工作和与专家讨论的系统搜索中推导出与安全用药流程相关的关键主题。在第二步中，指定每个关键主题的基本要求，并以基于文献的基本原理为依据对其进行证明。随后，采用经过试点的两轮 Delphi 研究对要求进行评估。
设置
瑞士的养老院。
参与者
来自科学和实践领域的 25 名跨专业专家组成的小组。
主要和次要结果测量
根据 RAND/UCLA 方法，使用 9 分李克特量表对每个要求对更安全和以患者为中心的用药的相关性进行评分。如果在第二轮中，中位数相关性评分≥7，且≥7 的评分比例≥80%，则认为该要求具有相关性。
结果
在 Delphi 研究中详细阐述并评估了五个关键主题，共 87 项要求。经过第二轮（两轮的回复率均为 100%），85 项要求满足了既定标准，因此被纳入最终的质量标准集。这五个关键主题是：（I）“定期在规定情况下审查药物”，（II）“以结构化方式审查药物”，（III）“以结构化方式监测药物”，（IV）“所有医疗保健专业人员都致力于实现最佳的跨专业合作”，以及（V）“患者积极参与药物治疗过程”。
结论
我们为瑞士养老院制定了更安全、以患者为中心的药物治疗的规范性质量标准。总共 85 项要求定义了药物治疗过程和医疗保健专业人员的行为。严格执行这些标准可能会支持养老院朝着更安全、以患者为中心的药物治疗方向迈进。
Zotero 插件