提高急诊医学临床医师对医院前管理药物的认识
Jeff Kamta1,2, Bryan Fregoso1, Andrew Lee3
1Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York.
Prehospital emergency care
|July 21, 2023
概括
改进紧急医疗服务 (EMS) 到紧急医疗 (EM) 信息传输提高了临床医生对医院前药物的认识,但并没有减少药物错误. 需要更好的系统集成,以有效减少错误.
科学领域:
- 紧急医疗 紧急医疗
- 医疗信息学 医疗信息学
- 患者安全 患者安全
背景情况:
- 紧急医疗服务 (EMS) 和紧急医疗 (EM) 之间的信息传输容易出现遗漏和错误.
- 医生对医院前药物管理的认识有限,影响患者管理和药物安全.
- 最初的调查显示,EM临床医生经常意识到医院前药物的低率 (20%).
研究的目的:
- 改善急诊室 (ED) 临床医生的医院前药物信息的文档和可访问性.
- 为了减少药物错误,特别是医院前德克萨米他给药后在ED中减少葡萄糖皮质体剂量,从30%降至10%.
主要方法:
- 实施了系统创新,将护理流程表中的医院前药物数据集成到分拣笔记中.
- 利用Shewhart p-图表来监测选笔记文档中的流程变化以及降低葡萄糖皮质醇剂量的结果变化.
- 对急诊医生和先进实践提供者进行了干预前后调查.
主要成果:
- 医院前药物管理的 triage note 文档增加,但没有观察到葡萄糖皮质醇再剂量率的统计变化.
- 干预后,临床医生对医院前药物的认识显著增加 (50%对20%,p=0.003).
- 大多数临床医生 (87%) 报告使用分拣笔记获取医院前药物信息,81%总是审查它们.
结论:
- 改善文档可访问性的系统创新与加强对医院前药物的主观意识相关.
- 干预措施没有显著降低药物错误的客观结果指标 (葡萄糖皮质醇剂量减少).
- 有效减少药物错误需要改善医院前和急诊医疗记录之间的系统集成.
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