一种新的建构主义理论指导的反馈干预措施能否减少处方错误？一项前后研究。
Can a novel constructivist theory-informed feedback intervention reduce prescribing errors ? A pre-post study.
机构信息
School of Pharmacy, University of Queensland, 20 Cornwall St, Woolloongabba, QLD, 4102, Australia.
Pharmacy Department, Royal Brisbane and Women's Hospital, Butterfield Street, Brisbane, QLD, 4029, Australia.
出版信息
BMC Med Educ. 2023 Mar 7;23(1):150. doi: 10.1186/s12909-023-04095-6.
CONTEXT
Medical interns (interns) find prescribing challenging and many report lacking readiness when commencing work. Errors in prescribing puts patients' safety at risk. Yet error rates remain high, despite education, supervision and pharmacists' contributions. Feedback on prescribing may improve performance. Yet, work-based prescribing feedback practices focus on rectifying errors. We aimed to explore if prescribing can be improved using a theory-informed feedback intervention.
METHODS
In this pre-post study, we designed and implemented a constructivist-theory informed prescribing feedback intervention, informed by Feedback-Mark 2 Theory. Interns commencing internal medicine terms in two Australian teaching hospitals were invited to engage in the feedback intervention. Their prescribing was evaluated by comparing errors per medication order of at least 30 orders per intern. Pre/baseline (weeks 1-3) were compared with post intervention (weeks 8-9). Interns' baseline prescribing audit findings were analysed and discussed at individualised feedback sessions. These sessions were with a clinical pharmacologist (Site 1) and a pharmacist educator (Site 2).
RESULTS
Eighty eight intern's prescribing over five 10-week terms was analysed from two hospitals. The frequency of prescribing errors significantly reduced at both sites after the intervention, across all five terms (p < 0.001).There were initially 1598 errors in 2750 orders (median [IQR] 0.48 [0.35-0.67] errors per order) and after the intervention 1113 errors in 2694 orders (median [IQR] 0.30 [0.17-0.50] errors per order).
CONCLUSION
Our findings suggest interns' prescribing practices may improve as a result of constructivist -theory learner centred, informed feedback with an agreed plan. This novel intervention, contributed, to a reduction in interns' prescribing errors. This study suggests new strategies for improving prescribing safety should include the design and implementation of theory-informed feedback interventions.
背景
医学实习生（interns）在开处方时感到困难重重，许多人在开始工作时表示缺乏准备。处方错误会使患者面临安全风险。尽管已经开展了教育、监督和药剂师的工作，但错误率仍然居高不下。关于处方的反馈可能会提高绩效。然而，基于工作的处方反馈实践侧重于纠正错误。我们旨在探索是否可以使用基于理论的反馈干预来改善处方。
方法
在这项前后研究中，我们设计并实施了一种基于建构主义理论的处方反馈干预措施，该干预措施受反馈标志 2 理论的启发。在澳大利亚两所教学医院开始内科实习的实习生被邀请参与反馈干预。通过比较每位实习生至少 30 张处方的每张处方的错误数量，评估他们的处方。干预前/基线（第 1-3 周）与干预后（第 8-9 周）进行比较。分析并讨论了实习生的基线处方审核结果，在个体化的反馈会议上进行。这些会议分别在临床药理学家（站点 1）和药剂师教育者（站点 2）进行。
结果
从两所医院的五个 10 周实习期中分析了 88 名实习生的处方。干预后，两个站点的所有五个术语的处方错误频率都显著降低（p < 0.001）。在 2750 张处方中有 1598 个错误（中位数[IQR] 0.48 [0.35-0.67]个错误/张），干预后在 2694 张处方中有 1113 个错误（中位数[IQR] 0.30 [0.17-0.50]个错误/张）。
结论
我们的研究结果表明，由于基于建构主义的学习者为中心的、有针对性的反馈和商定的计划，实习生的处方实践可能会得到改善。这种新的干预措施有助于减少实习生的处方错误。本研究表明，提高处方安全性的新策略应包括设计和实施基于理论的反馈干预措施。
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