护士对药物管理错误的看法以及与他们在新生儿重症监护病房报告相关的因素
Josephine Henry Basil1, Chandini Menon Premakumar1, Adliah Mhd Ali1
1Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia.
概括
护士报告的药物管理错误 (MAE) 不足,只有30.6%的错误被报告. 常见的原因包括人员问题和类似的药物包装,而专注于个人责怪则阻碍了报告.
科学领域:
- 护理实践 护理实践
- 患者安全 患者安全
- 改善医疗保健质量 改善医疗保健质量
背景情况:
- 药物管理错误 (MAE) 对患者的安全构成重大风险,并带来巨大的经济成本.
- 对MAE报告不足使当前错误情景的分析变得复杂,并阻碍了系统层面的改进.
研究的目的:
- 从护理的角度研究MAE的原因.
- 为了确定MAE报告不足的原因.
- 估计MAE报告的流行率和相关因素.
主要方法:
- 一项横截面研究,使用一个验证的自我管理问卷,分发给马来西亚新生儿重症监护病房的143名护士.
- 调查问卷评估了MAE发生的原因,不报告的原因以及报告的MAE的百分比.
- 采用多变量逻辑回归分析来确定与MAE报告相关的因素.
主要成果:
- 估计的MAE报告率为30.6%.
- MAE的主要原因包括护理人员不足,外形相似的药物和类似的药物包装.
- 不报告的主要原因是关注个人对系统问题的责怪以及将MAE作为质量指标的使用.
结论:
- 在护理实践中,MAE报告不足仍然是一个重要问题,报告错误不到三分之一.
- 影响报告的因素包括行政响应,报告工作,以及拥有高级文凭的护士.
- 促进错误报告需要强调报告的好处,采用非惩罚性措施,并培养无责文化.
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