Cole Evan, Duncan Rosemary, Grucz Traci, Watt Ian, Cardona Gonzalez Mariela, Sugrue David, McNew Sierra
Inova Fairfax Medical Campus, Falls Church, VA, USA.
The Johns Hopkins Hospital, Baltimore, MD, USA.
Hosp Pharm. 2024 Dec;59(6):638-644. doi: 10.1177/00185787241257416. Epub 2024 Jun 1.
When medication administration record (MAR) "hold" capability is enabled in the electronic health record (EHR) during patient transfers, medication doses appear as "held" rather than due. We sought to quantify the incidence of delayed and missed doses of critical medications during MAR hold periods and to implement and evaluate interdisciplinary efforts and technical interventions to reduce missed medication doses during these periods. A list of critical medications was identified. MAR data were collected in patients with at least 1 critical medication dose due during the MAR hold period. MAR times were used to determine if delayed doses or missed doses occurred. Our interventions included: (1) implementation of a patient list indicator to retrospectively identify recently "held" medication doses, and (2) a report for operating room pharmacists to prospectively identify upcoming doses and ensure they were administered on time. Pre- and post-intervention period data were compared using a chi-squared test. During the pre-intervention study period, there were 1044 instances of delayed or missed doses during MAR hold. Most MAR times evaluated were on MAR hold during perioperative patient transfers. Delayed, missed, and multiple missed doses were defined in accordance with internal medication administration policies. There was no significant difference in the incidence of delayed and missed doses (69% vs 66%, = .31), however, there was a significant reduction in the number of critical medication doses missed multiple times (0.8% vs 6.7%, < .001) and all missed doses (35% vs 42%, = .05) between the pre- and post-intervention period. As demonstrated across in both the pre- and post-intervention period of our study, MAR hold is commonly associated with dose delays and missed doses, which has potential negative consequences on patient outcomes. Future considerations will include implementation of a best practice alert (BPA) that directs users to a MAR tab highlighting doses held during transfers.
当在患者转院期间电子健康记录（EHR）中启用用药记录（MAR）“暂停”功能时，药物剂量显示为“已暂停”而非应给药。我们试图量化MAR暂停期间关键药物剂量延迟和漏服的发生率，并实施和评估跨学科措施及技术干预，以减少这些期间的药物漏服情况。确定了一份关键药物清单。收集在MAR暂停期间至少有1剂关键药物应给药的患者的MAR数据。利用MAR时间来确定是否发生剂量延迟或漏服。我们的干预措施包括：（1）实施患者清单指标以回顾性识别最近“已暂停”的药物剂量，以及（2）为手术室药师提供一份报告，以便前瞻性识别即将到来的剂量并确保按时给药。采用卡方检验比较干预前后的数据。在干预前的研究期间，MAR暂停期间有1044例剂量延迟或漏服情况。评估的大多数MAR时间是在围手术期患者转院期间处于MAR暂停状态。延迟、漏服和多次漏服剂量根据内部用药管理政策进行定义。延迟和漏服剂量的发生率没有显著差异（69%对66%，P = 0.31），然而，干预前后多次漏服关键药物剂量的数量有显著减少（0.8%对6.7%，P < 0.001），所有漏服剂量也有显著减少（35%对42%，P = 0.05）。正如我们研究的干预前后阶段所表明的，MAR暂停通常与剂量延迟和漏服有关，这可能对患者结局产生潜在负面影响。未来的考虑将包括实施最佳实践警报（BPA），引导用户进入MAR标签页，突出显示转院期间暂停的剂量。
