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首页> 外文期刊>The joint commission journal on quality and patient safety >Involving Intensive Care Unit Nurses in a Proactive Risk Assessment of the Medication Management Process
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Involving Intensive Care Unit Nurses in a Proactive Risk Assessment of the Medication Management Process

机译：重症监护室护士参与药物管理过程的主动风险评估

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Background: Vulnerabilities in the medication management process can lead to serious patient harm. In intensive care units (ICUs), nurses represent the last line of defense against medication errors. Proactive risk assessment (PRA) offers methods for determining how processes can break down and how people involved in such processes can contribute to or recover from a breakdown. Such methods can also be used to identify ICU nurses' contribution to the quality and safety of medication management. Methods: Observation and interview data of ICU nurses' work were used to develop a rich description of the nursing medication management process. A PRA method was conducted in a cardiovascular ICU to identify and evaluate failure modes in the nursing medication management process. The contributing factors to the failure modes and the recovery processes used by nurses were also characterized. Results: A total of 54 failure modes were identified across the seven steps of the medication management process. For the 5 most critical failure modes, nurses listed 21 contributing factors and 21 recovery processes. Ways were identified to redesign the medication management process, one of which consists of dealing with work system factors that contribute to the most critical failure modes. Conclusions: From a data-analysis viewpoint, this PRA method permits one to address a variety of objectives. Different scoring methods can be used to focus on either frequency or criricality of failure modes; one may also focus on a specific step of the process under study. Fiforts in eliminating or mitigating contributing factors would help reduce the criticality of the failure modes in terms of their likelihood and impact on patients and/or nurses. Developing systems to support the recovery processes used by nurses may be another approach to process redesign.
机译：背景：药物管理过程中的漏洞可能导致严重的患者伤害。在重症监护病房（ICU）中，护士代表着预防用药错误的最后一道防线。主动风险评估（PRA）提供了确定流程如何崩溃以及流程中涉及的人员如何促成故障或从故障中恢复的方法。此类方法还可用于确定ICU护士对药物管理质量和安全的贡献。方法：使用ICU护士工作的观察和访谈数据来丰富护理药物管理过程的描述。在心血管ICU中进行了PRA方法，以识别和评估护理药物管理过程中的失败模式。还描述了影响护士使用的故障模式和恢复过程的因素。结果：在药物管理过程的七个步骤中，共确定了54种失败模式。对于5种最关键的故障模式，护士列出了21个影响因素和21个恢复过程。确定了重新设计药物管理过程的方法，其中一种方法是处理影响最关键故障模式的工作系统因素。结论：从数据分析的角度来看，这种PRA方法可以解决各种目标。可以使用不同的评分方法来关注失败模式的发生频率或严重程度。人们可能还会关注研究过程的特定步骤。消除或减轻影响因素的努力将有助于降低故障模式在其可能性以及对患者和/或护士的影响方面的重要性。开发支持护士使用的恢复过程的系统可能是重新设计过程的另一种方法。

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    Helene Faye; A. Joy Rivera-Rodriguez; Ben-Tzion Karsh; Ann Schoofs Hundt; Christine Baker; Pascale Carayon;

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    Center for Quality and Productivity Improvement, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin Institut de Radioprotection et de Surete Nucleaire, Direction Surete des Reacteurs-Service d'Etude des Facteurs Humains, Fontenay-aux-Roses, France;

    rnDepartment of Industrial and Systems Engineering, University of Wisconsin-Madison;

    rnCenter for Quality and Productivity Improvement;

    rnCenter for Quality and Productivity Improvement;

    Quality and Safety Systems, St. Mary's Hospital, Madison;

    rnDepartment of Industriai and Systems Engineering Center for Quality and Productivity Improvement;

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