Primary care teams' reported actions to improve medication safety: a qualitative study with insights in high reliability organising.
Primary care teams' reported actions to improve medication safety: a qualitative study with insights in high reliability organising.
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DOI：
10.1136/bmjoq-2023-002350
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发表时间：
2023-09
期刊：
影响因子：
1.4
通讯作者：
中科院分区：
文献类型：
--
作者：
我们的目的是了解初级保健团队为提高用药安全性而采取的行动。这是一项定性研究，采用一对一，半结构化访谈的问题指导下的概念，从协作护理和系统工程模型，并参考老年人的护理。我们在2019-2020年期间采访了美国西南部四个初级保健中心的21名初级保健医生及其团队成员，他们为大多数社会经济地位较低的患者提供服务。我们使用主题分析结合归纳和演绎编码。首先，由多学科分析师团队使用归纳法逐步开发和迭代修订捕获安全措施的代码。从初级保健专业人员为提高用药安全性而采取的编码安全行动中出现的主题，然后使用演绎方法映射到高可靠性组织框架的关键原则。初级保健团队描述了他们在药物安全方面的行动，主要是制定标准护理医疗决策，患者共同决策，教育患者及其护理人员，提供与办公室访问分开的异步护理以及提供临床基础设施。大多数行动需要在个人层面上进行定制，例如限制某些处方药物的供应，简化某些患者的药物治疗方案。初级保健团队通过预测和减轻风险并采取行动在患者工作系统中建立弹性来制定高可靠性组织原则。初级保健团队的行动反映了他们的安全组织努力，作为对他们无法控制或难以协调的多种环境中的许多其他代理人的回应。初级保健团队采取了许多行动，以塑造社区环境中的药物安全结果，这些行动表明，初级保健团队是整个医疗保健系统中药物安全的弹性水库。为了提高用药安全性，初级保健工作系统需要不同的战略比那些经常使用的更独立的系统，如医院住院或手术服务。
Our aim was to understand actions by primary care teams to improve medication safety. This was a qualitative study using one-on-one, semistructured interviews with the questions guided by concepts from collaborative care and systems engineering models, and with references to the care of older adults. We interviewed 21 primary care physicians and their team members at four primary care sites serving patients with mostly low socioeconomic status in Southwest US during 2019–2020. We used thematic analysis with a combination of inductive and deductive coding. First, codes capturing safety actions were incrementally developed and revised iteratively by a team of multidisciplinary analysts using the inductive approach. Themes that emerged from the coded safety actions taken by primary care professionals to improve medication safety were then mapped to key principles from the high reliability organisation framework using a deductive approach. Primary care teams described their actions in medication safety mainly in making standard-of-care medical decisions, patient-shared decision-making, educating patients and their caregivers, providing asynchronous care separate from office visits and providing clinical infrastructure. Most of the actions required customisation at the individual level, such as limiting the supply of certain medications prescribed and simplifying medication regimens in certain patients. Primary care teams enacted high reliability organisation principles by anticipating and mitigating risks and taking actions to build resilience in patient work systems. The primary care teams’ actions reflected their safety organising efforts as responses to many other agents in multiple settings that they could not control nor easily coordinate. Primary care teams take many actions to shape medication safety outcomes in community settings, and these actions demonstrated that primary care teams are a reservoir of resilience for medication safety in the overall healthcare system. To improve medication safety, primary care work systems require different strategies than those often used in more self-contained systems such as hospital inpatient or surgical services.
影响因子：
2.8
作者：
Holmqvist M;Thor J;Ros A;Johansson L
通讯作者：
Johansson L