Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota.
Idaho College of Osteopathic Medicine, Meridian, Idaho.
West J Emerg Med. 2024 Jul;25(4):624-633. doi: 10.5811/westjem.18324.
Patients who stay in the emergency department (ED) for prolonged periods of time require verification of home medications, a process known as medication reconciliation. The complex nature of medication reconciliation can lead to adverse events and staff dissatisfaction. A multidisciplinary team was formed to improve accuracy, timing, and staff satisfaction with the medication reconciliation process.
Between November 2021-January 2022, stakeholders were surveyed to identify gaps in the medication reconciliation process. This project implemented education on role-specific tasks, as well as a "Let's chat!" huddle, bringing together the entire care team to perform medication reconciliation. We used real-time evaluations by frontline staff to evaluate effectiveness during plan- do-study-act cycles and obtain feedback. Following the implementation period, stakeholders completed the post-intervention survey between June-July 2022, using a 4-point Likert scale (0 = very dissatisfied to 3 = very satisfied). We calculated the change in staff satisfaction from pre-intervention to post-intervention. Differences in proportions and 95% confidence intervals are reported. This study adhered to the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) and followed the Lean Six Sigma rapid cycle process improvement (define-measure-analyze-improve-control).
A total of 111 front-line ED staff (physicians, nurse practitioners, physician assistants, pharmacists, nurses) completed the pre-intervention survey (of 350 ED staff, corresponding to a 31.7% response rate), and 89 stakeholders completed the post-intervention survey (a 25.4% response rate). Subjective feedback from staff identifying causes of low satisfaction with the initial process included the following: complexity of process; unclear delineation of staff roles; time burden to completion; high patient volume; and lack of standardized communication of task completion. Overall satisfaction improved after the intervention. The greatest improvement was seen in the correct medication (difference 20.7%, confidence interval [CI] 6.3-33.9%, < 0.01), correct dose (25.6%, CI 11.4-38.6%, < 0.001) and time last taken (24.5%, CI 11.4-37.0%, < 0.001).
There is a steep learning curve to educate multidisciplinary staff on a new process and implement the associated changes. With goals to impact the safety of our patients and reduce negative outcomes, engagement and awareness of the team involved in the medication reconciliation process is critical to improve staff satisfaction.
在急诊科（ED）停留时间较长的患者需要对家庭用药进行核实，这一过程被称为用药核对。用药核对的复杂性可能导致不良事件和员工不满。一个多学科团队成立，以提高用药核对过程的准确性、及时性和员工满意度。
在 2021 年 11 月至 2022 年 1 月期间，利益相关者接受调查，以确定用药核对过程中的差距。该项目实施了针对特定角色任务的教育，以及“让我们聊聊！”小组讨论，将整个护理团队聚集在一起进行用药核对。我们使用一线员工的实时评估，在计划-执行-研究-行动循环中评估效果，并获得反馈。在实施阶段之后，利益相关者于 2022 年 6 月至 7 月之间完成了干预后的调查，使用 4 分李克特量表（0=非常不满意，3=非常满意）。我们计算了干预前后员工满意度的变化。报告了比例和 95%置信区间的差异。本研究遵循了质量改进报告卓越标准（SQUIRE 2.0），并遵循了精益六西格玛快速循环过程改进（定义-测量-分析-改进-控制）。
共有 111 名一线 ED 员工（医生、护士从业人员、医师助理、药剂师、护士）完成了干预前的调查（350 名 ED 员工，对应 31.7%的回复率），89 名利益相关者完成了干预后的调查（25.4%的回复率）。员工对初始流程不满意的主观反馈包括：流程复杂；员工角色界定不明确；完成任务的时间负担；患者数量高；缺乏标准化的任务完成沟通。整体满意度在干预后有所提高。最大的改善是正确的药物（差异 20.7%，置信区间 [CI] 6.3-33.9%， < 0.01）、正确的剂量（25.6%，CI 11.4-38.6%， < 0.001）和最后一次服用时间（24.5%，CI 11.4-37.0%， < 0.001）。
对多学科员工进行新流程的教育和实施相关变革需要一个陡峭的学习曲线。为了影响我们患者的安全并减少不良后果，参与用药核对过程的团队的参与度和意识对于提高员工满意度至关重要。
