Divisions of Pediatric Hospital Medicine.
Departments of Quality Services.
Hosp Pediatr. 2024 Apr 1;14(4):300-307. doi: 10.1542/hpeds.2023-007396.
Medication reconciliation is a complex, but necessary, process to prevent patient harm from medication discrepancies. Locally, the steps of medication reconciliation are completed consistently; however, medication errors still occur, which suggest process inaccuracies. We focused on removal of unnecessary medications as a proxy for accuracy. The primary aim was to increase the percentage of patients admitted to the pediatric hospital medicine service with at least 1 medication removed from the home medication list by 10% during the hospital stay by June of 2022.
Using the Model for Improvement, a multidisciplinary team was formed at a children's hospital, a survey was completed, and multiple Plan-Do-Study-Act cycles were done focusing on: 1. simplifying electronic health record processes by making it easier to remove medications; 2. continuous resident education about the electronic health record processes to improve efficiency and address knowledge gaps; and 3. auditing charts and real-time feedback. Data were monitored with statistical process control charts.
The project exceeded the goal, improving from 35% to 48% of patients having at least 1 medication removed from their home medication list. Improvement has sustained for 12 months.
The combination of interventions including simplifying workflow, improving education, and enhancing accountability resulted in more patients with medications removed from their home medication list.
药物重整是一个复杂但必要的过程，可防止因药物差异而导致患者受到伤害。在本地，药物重整的步骤完成得一致；然而，药物错误仍然发生，这表明过程存在不准确之处。我们关注去除不必要的药物作为准确性的替代指标。主要目的是在 2022 年 6 月之前，通过住院治疗，将至少有 1 种药物从家庭用药清单中去除的儿科医院内科服务入院患者的百分比提高 10%。
使用改进模型，在一家儿童医院成立了一个多学科团队，完成了一项调查，并进行了多次计划-执行-研究-行动循环，重点关注：1. 通过简化电子病历流程来更容易地去除药物；2. 对电子病历流程进行持续的住院医师教育，以提高效率并解决知识差距；3. 审核图表和实时反馈。数据通过统计过程控制图进行监测。
该项目超过了目标，将至少有 1 种药物从家庭用药清单中去除的患者比例从 35%提高到 48%。改进已持续 12 个月。
包括简化工作流程、改善教育和增强问责制在内的干预措施的结合，使更多患者的家庭用药清单中去除了药物。
