在手术室输液泵上实施条形码给药管理（BMCA）技术。

Implementation of barcode medication administration (BMCA) technology on infusion pumps in the operating rooms.

机构信息

Anesthesiology, Erasmus MC, Rotterdam, The Netherlands.

Quality and Patientcare, Erasmus MC, Rotterdam, The Netherlands.

出版信息

BMJ Open Qual. 2023 May;12(2). doi: 10.1136/bmjoq-2022-002023.

DOI:10.1136/bmjoq-2022-002023

PMID:37217240

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10231014/

Abstract

BACKGROUND

Medication administration errors (MAEs) are a major cause of morbidity and mortality. An updated barcode medication administration (BCMA) technology on infusion pumps is implemented in the operating rooms to automate double check at a syringe exchange.

OBJECTIVE

The aim of this mixed-methods before-and-after study is to understand the medication administrating process and assess the compliance with double check before and after implementation.

METHODS

Reported MAEs from 2019 to October 2021 were analysed and categorised to the three moments of medication administration: (1) bolus induction, (2) infusion pump start-up and (3) changing an empty syringe. Interviews were conducted to understand the medication administration process with functional resonance analysis method (FRAM). Double check was observed in the operating rooms before and after implementation. MAEs up to December 2022 were used for a run chart.

RESULTS

Analysis of MAEs showed that 70.9% occurred when changing an empty syringe. 90.0% of MAEs were deemed to be preventable with the use of the new BCMA technology. The FRAM model showed the extent of variation to double check by coworker or BCMA.Observations showed that the double check for pump start-up changed from 70.2% to 78.7% postimplementation (p=0.41). The BCMA double check contribution for pump start-up increased from 15.3% to 45.8% (p=0.0013). The double check for changing an empty syringe increased from 14.3% to 85.0% (p<0.0001) postimplementation. BCMA technology was new for changing an empty syringe and was used in 63.5% of administrations. MAEs for moments 2 and 3 were significantly reduced (p=0.0075) after implementation in the operating rooms and ICU.

CONCLUSION

An updated BCMA technology contributes to a higher double check compliance and MAE reduction, especially when changing an empty syringe. BCMA technology has the potential to decrease MAEs if adherence is high enough.

摘要

背景

用药错误（MAE）是发病率和死亡率的主要原因。手术室中实施了更新的输液泵条码给药（BCMA）技术，以实现注射器更换时的双重核对自动化。

目的

本混合方法的前后研究旨在了解给药过程，并评估实施前后的双重核对依从性。

方法

分析了 2019 年至 2021 年 10 月的报告 MAE，并将其分类为给药的三个时刻：（1）推注诱导，（2）输液泵启动，（3）更换空注射器。使用功能共振分析方法（FRAM）进行了访谈，以了解给药过程。在实施前后观察手术室的双重核对。截至 2022 年 12 月的 MAE 用于运行图。

结果

MAE 分析显示，70.9%的 MAE 发生在更换空注射器时。使用新的 BCMA 技术可预防 90.0%的 MAE。FRAM 模型显示了同事或 BCMA 对双重核对的变化程度。观察结果显示，启动输液泵的双重核对从实施后从 70.2%增加到 78.7%（p=0.41）。BCMA 对输液泵启动的双重核对贡献从 15.3%增加到 45.8%（p=0.0013）。实施后更换空注射器的双重核对从 14.3%增加到 85.0%（p<0.0001）。更换空注射器时的 BCMA 技术是新的，在 63.5%的给药中使用。实施后，手术室和 ICU 中第 2 时刻和第 3 时刻的 MAE 显著降低（p=0.0075）。