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首页> 外文期刊>The joint commission journal on quality and patient safety >Making Inpatient Medication Reconciliation Patient Centered, Clinically Relevant, and Implementable: A Consensus Statement on Key Principles and Necessary First Steps
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Making Inpatient Medication Reconciliation Patient Centered, Clinically Relevant, and Implementable: A Consensus Statement on Key Principles and Necessary First Steps

机译：使住院药物和解患者居中，在临床上相关且可实施：关于关键原则和必要的第一步的共识声明

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Medication errors and adverse events caused by them are common during and after a hospitalization. The impact of these events on patient welfare and the financial burden, both to the patient and the health care system, are significant. In 2005, The Joint Commission put forth medication reconciliation as National Patient Safety Goal (NPSG) 8 in an effort to minimize adverse events caused during these types of care transitions. However, the meaningful and systematic implementation of medication reconciliation, as expressed through NPSG 8, proved to be difficult for many health care institutions around the United States.rnGiven the importance of accurate and complete medication reconciliation for patient safety occurring across the continuum of care, the Society of Hospital Medicine convened a stakeholder conference in March 2009 to begin to identify and address (1) barriers to implementation, (2) opportunities to identify best practices surrounding medication reconciliation, (3) the role of partnerships among traditional health care sites and nonclinical and other community-based organizations, and 4) metrics for measuring the processes involved in medication reconciliation and their impact on preventing harm to patients. The focus of the conference was oriented toward medication reconciliation for a hospitalized patient population; however, many of the themes and concepts derived would also apply to other care settings. This white paper highlights the key domains needing to be addressed and suggests first steps toward doing so.rnAn overarching principle derived at the conference is that medication reconciliation should not be viewed as primarily an accreditation function. It must, first and foremost, be recognized as an important element of patient safety. From this prin-rnciple, the participants identified 10 key areas requiring further attention in order to move medication reconciliation toward this focus.rn1. There is need for a uniformly acceptable and accepted definition of what constitutes a medication and what processes are encompassed by reconciliation. Clarifying these terms is critical to ensuring more uniform impact of medication reconciliation.rn2. The varying roles of the multidisciplinary participants in the reconciliation process must be clearly defined. These role definitions should include those of the patient and family/care-giver and must occur locally, taking into account the need for flexibility in design given the varying structures and resources at health care sites.rn3. Measures of the reconciliation processes must be clinically meaningful (that is, of defined benefit to the patient) and derived through consultation with stakeholder groups. Those measures to be reported for national benchmarking and accreditation should be limited in number and clinically meaningful.rn4. While a comprehensive reconciliation system is needed across the continuum of care, a phased approach to implementation, allowing it to start slowly and be tailored to local organizational structures and work flows, will increase the chances of successful organizational uptake.rn5. Developing mechanisms for prospectively and proactive-ly identifying patients at risk for medication-related adverse events and failed reconciliation is needed. Such an alert system would help maintain vigilance toward these patient safety issues and help focus additional resources on high-risk patients.rn6. Given the diversity in medication reconciliation practices, research aimed at identifying effective processes is important and should be funded with national resources. Funding should include varying sites of care (for example, urban and rural, aca-rndemic and nonacademic).rn7. Strategies for medication reconciliation-both successes and key lessons learned from unsuccessful efforts-should be widely disseminated.rn8. A personal health record that is integrated and easily transferable between sites of care is needed to facilitate successful medication reconciliation.rn9. Partnerships between health care organizations and community-based organizations create opportunities to reinforce medication safety principles outside the traditional clinician-patient relationship. Leveraging the influence of these organizations and other social-networking platforms may augment population-based understanding of their importance and role in medication safety.rn10. Aligning health care payment structures with medication safety goals is critical to ensure allocation of adequate resources to design and implement effective medication reconciliation processes.rnMedication reconciliation is complex and made more complicated by the disjointed nature of the American health care system. Addressing these 10 points with an overarching goal of focusing on patient safety rather than only accreditation should result in improvements in medication reconciliation and the health of patients.
机译：由它们引起的用药错误和不良事件在住院期间和之后都很常见。这些事件对患者和医疗系统的患者福利和财务负担的影响是巨大的。 2005年，联合委员会将药物和解列为国家患者安全目标（NPSG）8，以最大程度地减少此类护理过渡期间造成的不良事件。但是，通过NPSG 8表示，有意义和系统地实施药物和解对美国许多医疗机构来说都是困难的。鉴于在整个护理过程中，准确而完整的药物和解对患者安全的重要性，医院医学协会于2009年3月召开了一次利益相关者会议，以开始确定和解决（1）实施障碍，（2）识别围绕药物和解的最佳实践的机会，（3）传统医疗机构之间的合作伙伴关系的作用和非临床组织和其他基于社区的组织，以及4）用于衡量药物和解所涉及的过程及其对防止对患者造成伤害的影响的指标。会议的重点是针对住院患者的药物调和。但是，衍生的许多主题和概念也将适用于其他护理环境。本白皮书重点介绍了需要解决的关键领域，并提出了迈出的第一步。会议得出的总体原则是，药物和解不应被视为主要的认证功能。首先，必须将其视为患者安全的重要要素。参与者从这一原理中确定了10个需要进一步关注的关键领域，以便使药物和解朝着这一重点发展。需要对药物的构成以及和解包含的过程进行统一接受和接受的定义。澄清这些术语对于确保药物和解产生更统一的影响至关重要。必须明确定义多学科参与者在和解过程中的不同角色。这些角色定义应包括患者和家属/护理人员的角色定义，并且必须在本地进行，并考虑到由于医疗机构的结构和资源各异而需要灵活设计。和解过程的度量必须具有临床意义（即对患者具有确定的益处），并且必须与利益相关者团体协商得出。报告用于国家基准和认证的措施应数量有限且具有临床意义。rn4。尽管在整个护理过程中都需要一个全面的和解系统，但分阶段实施的方法允许它缓慢启动并针对本地组织结构和工作流程进行量身定制，这将增加成功采用组织的机会。rn5。需要开发一种机制来前瞻性和主动地识别有药物相关不良事件和和解失败风险的患者。这样的警报系统将有助于保持对这些患者安全问题的警惕，并有助于将更多资源集中在高风险患者身上。鉴于药物和解做法的多样性，旨在确定有效程序的研究很重要，应由国家资源资助。资金应包括各种护理地点（例如，城市和农村，学术界和非学术界）。应当广泛传播药物和解战略，包括成功的经验和从不成功的努力中学到的关键经验教训。rn8。需要一个完整的个人健康记录，并且可以在护理地点之间轻松转移这些记录，以促进药物和解的成功。卫生保健组织和社区组织之间的合作关系为加强传统临床医生与患者之间关系以外的药物安全原则创造了机会。利用这些组织和其他社交网络平台的影响力，可以增强基于人群的认识，了解他们在药物安全中的重要性和作用。使医疗保健支付结构与药物安全目标保持一致对于确保分配足够的资源来设计和实施有效的药物对帐流程至关重要。由于美国医疗体系的脱节性质，药物对帐非常复杂，而且变得更加复杂。着眼于这十点，其首要目标是关注患者的安全而不是仅仅通过认证，这将导致药物和解和患者健康的改善。

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    Jeffrey L. Greenwald; Lakshmi K. Halasyamani; Jan Greene; Cynthia LaCivita; Erin Stucky; Bona Benjamin; William Reid; Frances A. Griffin; Allen J. Vaida; Mark V. Williams;

  • 作者单位

    Harvard Medical School, Department of Medicine, Inpatient Clinician Educator Service, Massachusetts General Hospital, Boston;

    rnQuality and Systems Improvement, Saint Joseph Mercy Health System, Trinity Health, Ann Arbor, Michigan;

    rn;

    rnEducation and Special Programs, American Society of Health-System Pharmacists, Research and Education Foundation, Bethesda, Maryland;

    rnUniversity of California San Diego Department of Pediatrics, and Rady Children's Hospital and Health Center, San Diego;

    rnMedication-Use Quality Improvement Practice Development Division, American Society of Health-System Pharmacists;

    rnProduct Management, Health Solutions Group, Microsoft Corporation, Redmond, Washington;

    rnInstitute for Healthcare Improvement, Cambridge, Massachusetts;

    Institute for Safe Medication Practices, Horsham, Pennsylvania;

    rnDivision of Hospital Medicine, Northwestern University, and Feinberg School of Medicine, Chicago;

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