Understanding Hazards for Adverse Drug Events Among Older Adults After Hospital Discharge: Insights From Frontline Care Professionals.
Understanding Hazards for Adverse Drug Events Among Older Adults After Hospital Discharge: Insights From Frontline Care Professionals.
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DOI：
10.1097/pts.0000000000001046
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发表时间：
2022-12-01
影响因子：
2.2
通讯作者：
Gurses, Ayse P.
中科院分区：
文献类型：
--
作者：
Xiao, Yan;Smith, Aaliyah;Abebe, Ephrem;Hannum, Susan M.;Wessell, Andrea M.;Gurses, Ayse P.
关键词：
护理过渡对不良药物事件(ADE)具有很高的风险。我们的目标是使用系统方法确定在护理过渡期间对老年人用药安全的危险。来自4家医院的住院专业人员就老年人出院后的ADE风险进行了采访。从采访记录中提取担忧，对于每个担忧，根据人的因素和系统工程模型，对与药物相关的伤害的风险进行编码，并根据其来源进行分组，该模型将出院后的不良反应视为专业和患者家庭工作系统的结果。38名专业人员参加(5名医院医生、24名护士、4名临床药剂师、3名药房技术员和2名社会工作者)。危险因素分为6组，按危险因素的频数排序：(1)与家庭有关的用药任务；(2)与病人及照顾者有关的危险；(3)与医院工作制度有关的危险；(4)与家庭资源有关的危险；(5)与医院专业与病人合作有关的危险；(6)与外部环境有关的危险。在描述担忧时，最常被引用的药物包括抗凝剂、胰岛素和利尿剂。排名最靠前的危险类型是复杂的剂量、患者和护理者在药物管理方面的知识差距、出院药物的错误、负担不起的费用、对药物变化的不充分了解，以及在获得护理或分享药物信息方面的差距。从医院一线医护人员的角度来看，在护理过渡期间与药物相关的伤害的危险是多因素的，代表了医院工作系统引入的危险，以及家庭工作系统中未被认识到和未解决的缺陷。
Care transitions pose high risk for adverse drug events (ADEs). We aimed to identify hazards to medication safety for older adults during care transitions using a systems approach. Hospital-based professionals from 4 hospitals were interviewed about ADE risks following hospital discharge among older adults. Concerns were extracted from the interview transcript, and for each concern, hazard for medication-related harms was coded and grouped by its sources according to a human factors and systems engineering model that views post-discharge ADEs as the outcome of professional and patient home work systems. Thirty-eight professionals participated (five hospitalists, 24 nurses, four clinical pharmacists, three pharmacy technicians, and two social workers). Hazards were classified into six groups, ranked by frequencies of hazards coded: (1) medication tasks related at home, (2) patient and caregiver related, (3) hospital work system related, (4) home resource related, (5) hospital professional-patient collaborative work related, and (6) external environment related. Medications most frequently cited when describing concerns included anticoagulants, insulins, and diuretics. Top coded hazard types were complex dosing, patient and caregiver knowledge gaps in medication management, errors in discharge medications, unaffordable cost, inadequate understanding about changes in medications, and gaps in access to care or in sharing medication information. From the perspective of hospital-based frontline healthcare professionals, hazards for medication-related harms during care transitions were multi-factorial and represented those introduced by the hospital work system as well as defects unrecognized and unaddressed in the home work system.