快速反应系统、抗生素管理和药物调节:关于实施因素、活动和结果的范围综述。

IF 5.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Jonas Torp Ohlsen, Eirik Søfteland, Per Espen Akselsen, Jörg Assmus, Stig Harthug, Regina Küfner Lein, Nick Sevdalis, Hilde Valen Wæhle, John Øvretveit, Miriam Hartveit
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引用次数: 0

摘要

导言:尽管在质量改进方面做出了大量努力,但许多患者安全实践在常规临床护理中仅得到了部分认可。实施科学可以帮助我们深入了解如何成功采用患者安全措施:我们的目的是研究三种国际通用安全实践的实施文献:用药核对、抗生素管理计划和快速反应系统。我们试图确定所报道的实施活动、因素和结果;支持成功实施的因素和活动组合;以及当前证据基础对未来实施和研究的影响:我们检索了 2011 年 1 月至 2023 年 3 月期间的 Medline、Embase、Web of Science、Cumulative Index to Nursing and Allied Health Literature、PsycINFO 和 Education Resources Information Center。我们纳入了经同行评审的原创研究或质量改进报告。我们采用迭代归纳法对数据进行主题分类。我们进行了描述性统计和分层聚类分析:从纳入的 159 项研究中,我们确定了八类实施活动:教育、计划和准备、基于方法的方法、审核和反馈、激励和提醒、资源分配、模拟和培训以及患者参与。大多数研究报告了多个类别的活动。实施因素包括:临床能力与合作;资源;准备与参与;外部影响;组织参与;质量改进能力;以及创新的可行性。这些因素往往是事后提出的,很少用于指导实施策略的选择。报告的实施结果包括:忠实性或合规性、忠实性的替代指标、可持续性、可接受性和传播性。大多数研究报告了实施工作的改进情况,这阻碍了对重要或不重要的因素和活动进行区分:结论:实施患者安全实践的多种活动主要反映了基于方法的改进科学,其次是来自实施科学的决定性框架。为应对不断变化的环境,对实施活动进行持续调整的潜力似乎尚未得到开发。关于如何进行此类调整的研究指导可推动实践中的实施工作。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Rapid response systems, antibiotic stewardship and medication reconciliation: a scoping review on implementation factors, activities and outcomes.

Introduction: Many patient safety practices are only partly established in routine clinical care, despite extensive quality improvement efforts. Implementation science can offer insights into how patient safety practices can be successfully adopted.

Objective: The objective was to examine the literature on implementation of three internationally used safety practices: medication reconciliation, antibiotic stewardship programmes and rapid response systems. We sought to identify the implementation activities, factors and outcomes reported; the combinations of factors and activities supporting successful implementation; and the implications of the current evidence base for future implementation and research.

Methods: We searched Medline, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Education Resources Information Center from January 2011 to March 2023. We included original peer-reviewed research studies or quality improvement reports. We used an iterative, inductive approach to thematically categorise data. Descriptive statistics and hierarchical cluster analyses were performed.

Results: From the 159 included studies, eight categories of implementation activities were identified: education; planning and preparation; method-based approach; audit and feedback; motivate and remind; resource allocation; simulation and training; and patient involvement. Most studies reported activities from multiple categories. Implementation factors included: clinical competence and collaboration; resources; readiness and engagement; external influence; organisational involvement; QI competence; and feasibility of innovation. Factors were often suggested post hoc and seldom used to guide the selection of implementation strategies. Implementation outcomes were reported as: fidelity or compliance; proxy indicator for fidelity; sustainability; acceptability; and spread. Most studies reported implementation improvement, hindering discrimination between more or less important factors and activities.

Conclusions: The multiple activities employed to implement patient safety practices reflect mainly method-based improvement science, and to a lesser degree determinant frameworks from implementation science. There seems to be an unexploited potential for continuous adaptation of implementation activities to address changing contexts. Research-informed guidance on how to make such adaptations could advance implementation in practice.

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来源期刊
BMJ Quality & Safety
BMJ Quality & Safety HEALTH CARE SCIENCES & SERVICES-
CiteScore
9.80
自引率
7.40%
发文量
104
审稿时长
4-8 weeks
期刊介绍: BMJ Quality & Safety (previously Quality & Safety in Health Care) is an international peer review publication providing research, opinions, debates and reviews for academics, clinicians and healthcare managers focused on the quality and safety of health care and the science of improvement. The journal receives approximately 1000 manuscripts a year and has an acceptance rate for original research of 12%. Time from submission to first decision averages 22 days and accepted articles are typically published online within 20 days. Its current impact factor is 3.281.
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