Improving medication safety in the perioperative setting: development of a medication use process.

IF 9.2 1区 医学 Q1 ANESTHESIOLOGY
Almudena Ribed, Álvaro Giménez-Manzorro, Ana de Lorenzo-Pinto, Beatriz Torroba-Sanz, M D Ginel-Feito, P Cabrerizo-Torrente, M L Martín Barbero, Ana Herranz, María Sanjurjo
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Abstract

Background: Medication errors are highly prevalent in the perioperative setting. The objectives of this study were to re-engineer the medication use process in the perioperative setting and to draft safety recommendations to improve safe medication use in daily practice.

Methods: A group coordinated by medical centre management and composed of pharmacists, surgeons, anaesthesiologists, nurses, and information technicians was formed in 2020. A failure mode and effects analysis was performed to assess the perioperative use of drugs in surgical patients from preadmission to discharge, and 25 failure modes were identified. A bibliographic review was carried out to detect and prioritise safety strategies according to the failure modes detected. The risk priority number was calculated before and after implementation of the safety strategies.

Results: A new medication use process was defined and eight safety strategies were implemented to improve perioperative drug safety. These strategies included implementation of automated dispensing cabinets, preparation of general anaesthesia trays with ready-to-administer medications, development and implementation of a one-step computerised provider order entry system for prescribing and administration in the operating room with barcode registration technology, implementation of a pharmaceutical care programme for surgical patients based on medication reconciliation at all transitions of care, and implementation of new alerts in the clinical decision support system linked to computerised provider order entry to improve pain, anticoagulation, and antibiotic management during surgical follow-up. The risk priority number for critical failure modes changed from 229.5 to 62.8 after implementation of the safety strategies, corresponding to a 72.9% decrease (P=0.016).

Conclusions: A new process was implemented based on integrated multidisciplinary care and a strong commitment to technology that promotes safe medication use throughout the perioperative setting.

提高围手术期用药安全:药物使用流程的发展。
背景:围手术期用药错误非常普遍。本研究的目的是重新设计围手术期的用药过程,并起草安全建议,以提高日常用药的安全性。方法:2020年组建由药师、外科医生、麻醉师、护士、信息技术人员组成的医疗中心管理协调小组。对手术患者入院前至出院围手术期药物使用进行失效模式及效果分析,共鉴定出25种失效模式。根据检测到的故障模式,进行了文献回顾,以检测和优先考虑安全策略。计算安全策略实施前后的风险优先级数。结果:制定了新的用药流程,实施了8项安全策略,提高了围手术期用药安全性。这些策略包括实施自动配药柜,准备全麻托盘,准备随时可以给药的药物,开发和实施一步电脑化提供者订单输入系统,在手术室使用条形码登记技术进行处方和给药,在所有护理过渡阶段实施基于药物对账的手术患者药物护理计划,并在临床决策支持系统中实施新的警报,该系统与计算机化的提供者订单输入相关联,以改善手术随访期间的疼痛、抗凝和抗生素管理。实施安全策略后,关键失效模式的风险优先级由229.5降至62.8,降低了72.9% (P=0.016)。结论:基于综合多学科护理和对促进围手术期安全用药的技术的坚定承诺,实施了一个新的过程。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
13.50
自引率
7.10%
发文量
488
审稿时长
27 days
期刊介绍: The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.
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