Multidisciplinary systems approach to chemotherapy safety: Rebuilding processes and holding the gains
Multidisciplinary systems approach to chemotherapy safety: Rebuilding processes and holding the gains
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DOI：
10.1200/jco.2002.04.108
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发表时间：
2002-12-15
影响因子：
45.3
通讯作者：
Barnsteiner, JH
中科院分区：
文献类型：
--
作者：
Womer, RB;Tracy, E;Barnsteiner, JH
目的：药物安全问题在很大程度上是由于一次化疗失误引起的，而抗癌药物的高毒性和低治疗指数使得其处方和给药的安全性至关重要。我们已经对住院化疗系统进行了彻底的修订。方法：我们参与了卫生保健改善研究所的一个多机构合作项目，并使用了他们的快速周期变化方法。特别强大的系统改变概念是驱除恐惧，“捕获”错误并从中学习，关注结果而不是输入，简化和标准化，使用约束和“强制功能”，减少移交，并关注人为因素。结果：将这些概念应用到我们的化疗输送系统中，我们已经将每1000次化疗剂量实际达到患者的化疗错误数量减少了84%，并且持续了5年。结论：快速的周期变化方法、医院管理层的大力支持是我们成功的因素；草根参与，跨学科合作的传统。计算机化的直接医嘱输入和合作小组参与产生了混合效果。持续改进的努力是保持我们的成果的关键。虽然具体的问题和变化可能与其他组织无关，但我们使用的概念和方法是普遍适用的。
Purpose: The problem of medication safety came to public attention largely through a chemotherapy error, and the high toxicity and low therapeutic index of anticancer medications make safety in their prescription and administration critical. We have undertaken a thorough revision of our systems for inpatient chemotherapy.Methods: We participated in a multi-institutional collaborative effort of the Institute for Healthcare Improvement, and used their rapid cycle change method. Particularly powerful systems change concepts were driving out fear, "trapping" errors and learning from them, focusing on outcome rather than on input, simplifying and standardizing, using constraints and "forcing functions," reducing handoffs, and paying attention to human factors.Results: Applying these concepts to our chemotherapy delivery system, we have achieved an 84% decrease in the number of chemotherapy errors that actually reach patients per 1,000 chemotherapy doses, and have sustained that improvement for 5 years.Conclusion: Factors contributing to our success include the rapid cycle change method, strong support from hospital administration; grassroots participation, and a tradition of interdisciplinary cooperation. Computerized direct physician order entry and cooperative group participation have had mixed effects. Continued efforts at improvement have been key to holding our gains. Although specific problems and changes may not be relevant to other organizations, the concepts and methods we used are generally applicable.