从医嘱到离院：优化儿科患者出院带药流程的质量改进方法。

Meds to Beds: A Quality Improvement Approach to Optimizing the Discharge Medication Process for Pediatric Patients.

出版信息

Jt Comm J Qual Patient Saf. 2022 Feb;48(2):92-100. doi: 10.1016/j.jcjq.2021.09.014. Epub 2021 Oct 4.

DOI:10.1016/j.jcjq.2021.09.014

Abstract

BACKGROUND

Using an on-site pharmacy or medication to bedside (MTB) program allows patients to obtain prescriptions and education before discharge, potentially improving adherence and preventing harm. The aim of this project was to improve discharge processes for pediatric acute care patients by increasing the proportion of oral antibiotics (1) prescribed to the on-site pharmacy from 15% to 70% and (2) delivered to bedside from 0% to 50%.

METHODS

The Model for Improvement was used to iteratively implement interventions: increased on-site pharmacy capabilities, MTB program creation and streamlined enrollment, and secure electronic health record (EHR) messaging between clinicians and pharmacy staff regarding prescriptions. Process measures were proportion of antibiotics prescribed to the on-site pharmacy and delivered to bedside. Outcomes included surveys of family satisfaction with discharge medication education and discharge medication-related safety reports. Discharge before noon (DBN) was the balancing measure. Aims were analyzed using statistical process control charts and chi-square tests.

RESULTS

A total of 1,908 antibiotics were prescribed over 28-months. On-site pharmacy prescriptions increased from 15% to 46% after pharmacy capabilities increased, then to 86% after MTB program launch, optimized workflow, and initiation of EHR messaging. Bedside medication delivery increased from 0% to 58% with these interventions. Family satisfaction with discharge medication education and frequency of discharge medication-related safety reports was not significantly different pre- and postintervention. DBN varied throughout the study.

CONCLUSION

Through clinician and pharmacy staff partnership, this initiative increased on-site pharmacy use and discharge antibiotics delivered to bedside. Key interventions included increased pharmacy capabilities, MTB program with streamlined workflow, and EHR-based communication.

摘要

背景

使用现场药房或床边用药（MTB）计划可以让患者在出院前获得处方和教育，从而提高依从性并预防伤害。该项目的目的是通过提高现场药房开出的口服抗生素比例（1）从 15%提高到 70%，（2）从 0%提高到 50%，从而改善儿科急性护理患者的出院流程。

方法

使用改进模型（Model for Improvement）迭代实施干预措施：增加现场药房的能力、创建 MTB 计划并简化登记，以及在临床医生和药剂师之间使用安全的电子病历（EHR）消息传递来处理处方。过程衡量标准是开给现场药房的抗生素比例和送到床边的抗生素比例。结果包括对出院药物教育和出院药物相关安全报告的家庭满意度调查。中午前出院（DBN）是平衡措施。使用统计过程控制图和卡方检验分析目标。

结果

在 28 个月期间共开出 1908 种抗生素。在增加药房能力后，现场药房的处方从 15%增加到 46%，然后在推出 MTB 计划、优化工作流程和启动 EHR 消息传递后增加到 86%。通过这些干预措施，床边用药的比例从 0%增加到 58%。出院药物教育的家庭满意度和出院药物相关安全报告的频率在干预前后没有显著差异。DBN 在整个研究期间有所变化。