Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany.
Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany.
Eur J Hosp Pharm. 2022 Jan;29(1):33-39. doi: 10.1136/ejhpharm-2019-002027. Epub 2019 Dec 20.
In 2017, an in-house best-practice process for medication documentation was developed and implemented to meet the new German legal requirements concerning the management of patient discharge from the hospital. Because this law regulates the common steps of good discharge practices (eg, specification of discharge mediation documentation), we used its implementation to assess the impact of such a measure on the quality of medication documentation and related workflows in clinical routine.
By observing workflows and interviewing the affected employees, we analysed the medication workflow processes from admission to discharge of seven representative departments of a large university hospital before and early after implementation of a newly defined best-practice process. To investigate the implementation impact, following measures were determined overall and for five key process steps: quality of medication documentation as measured by predefined criteria, the adherence to the best-practice process (range 0%-100%), workload and potential shifts in responsibilities.
Already early after implementation, all departments met the legal requirements and the quality of the medication documentation increased from low to high quality in most departments. Mean adherence to the best-practice process was 77% (range 60%-100%) with strictest adherence of 100% in one department. Thereby, the number of process steps and hence, likely also the workload increased in all departments. New tasks were mainly performed by physicians and in one department by pharmacists.
The new lawful best-practice process led to a higher quality in medication documentation at the cost of a higher workload for physicians, potentially limiting time for other care tasks. Therefore, it could be important to define areas of the medication documentation process in which physicians could be supported by other professions or new tools facilitating accurate medication documentation as the basis of continuity of care.
2017 年，为满足德国新的有关患者出院管理的法律要求，制定并实施了内部最佳实践流程，以规范患者出院管理。由于该法律规定了良好出院实践的常见步骤（例如，规定出院调解文件），我们利用其实施来评估此类措施对临床常规药物管理记录质量和相关工作流程的影响。
通过观察工作流程并对受影响的员工进行访谈，我们在一家大型大学医院的七个代表性科室，在新定义的最佳实践流程实施之前和早期实施后，分析了从入院到出院的药物治疗工作流程。为了调查实施的影响，我们对总体情况和五个关键流程步骤进行了如下措施的确定：药物治疗记录质量（根据预定标准）、最佳实践流程的遵守情况（范围为 0%-100%）、工作量和潜在的职责转变。
在实施后不久，所有科室都达到了法律要求，并且大多数科室的药物治疗记录质量从低质量提高到了高质量。最佳实践流程的平均遵守率为 77%（范围为 60%-100%），一个科室的遵守率最严格为 100%。因此，所有科室的流程步骤数量增加，工作量可能也增加。新任务主要由医生承担，在一个科室由药剂师承担。
新的合法最佳实践流程以牺牲医生的更多工作量为代价，提高了药物治疗记录的质量，可能会限制其他护理任务的时间。因此，确定药物治疗记录流程中需要医生获得其他专业支持的领域，或需要新工具来促进准确的药物治疗记录，以作为连续性护理的基础，这一点非常重要。
