How can patient-held lists of medication enhance patient safety? A mixed-methods study with a focus on user experience
How can patient-held lists of medication enhance patient safety? A mixed-methods study with a focus on user experience
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DOI：
10.1136/bmjqs-2019-010194
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发表时间：
2020-09-01
影响因子：
5.4
通讯作者：
Franklin, Bryony Dean
中科院分区：
文献类型：
--
作者：
Garfield, Sara;Furniss, Dominic;Franklin, Bryony Dean
患者经常携带药物清单，以减轻医疗保健环境中的信息丢失。我们的目标是确定这些列表可用于支持安全性的机制，关键支持功能以及使用的障碍和促进因素。方法：我们使用了混合方法设计，包括两个焦点小组与患者和护理人员，16个半结构化的访谈与医疗保健专业人员，60个半结构化的访谈与携带药物清单的人，定量功能分析的工具，可供患者记录他们的药物和可用性测试的四个工具。使用专题分析对调查结果进行了三角分析。分布式认知的团队合作模式被用来作为敏感的概念。结果我们确定了一系列的机制，通过携带药物清单可以提高用药安全性。这些措施包括提高药物核对的准确性，允许识别潜在的药物相互作用，促进关于药物的沟通，在预约期间为患者提供备忘录，允许患者检查他们的药物是否有错误，并提醒患者服用和重新订购药物。不同的药物记录工具满足不同的需求。在审查的103个工具中，没有一个满足所有用户的核心需求。使用的一个关键障碍是患者和护理人员缺乏对医疗信息系统可能分散的认识，一个关键的促进因素是医疗专业人员的鼓励。结论我们的研究结果表明，患者和医疗保健专业人员认为患者持有的药物清单有各种各样的好处。需要采取干预措施，以提高对这些清单在加强患者安全方面的潜在作用的认识。这种干预措施应使患者和护理人员能够从一系列选择中确定最适合他们的方法，避免“一刀切”的方法。
Background Patients often carry medication lists to mitigate information loss across healthcare settings. We aimed to identify mechanisms by which these lists could be used to support safety, key supporting features, and barriers and facilitators to their use. Methods We used a mixed-methods design comprising two focus groups with patients and carers, 16 semistructured interviews with healthcare professionals, 60 semistructured interviews with people carrying medication lists, a quantitative features analysis of tools available for patients to record their medicines and usability testing of four tools. Findings were triangulated using thematic analysis. Distributed cognition for teamwork models were used as sensitising concepts. Results We identified a wide range of mechanisms through which carrying medication lists can improve medication safety. These included improving the accuracy of medicines reconciliation, allowing identification of potential drug interactions, facilitating communication about medicines, acting as an aide-memoire to patients during appointments, allowing patients to check their medicines for errors and reminding patients to take and reorder their medicines. Different tools for recording medicines met different needs. Of 103 tools examined, none met the core needs of all users. A key barrier to use was lack of awareness by patients and carers that healthcare information systems can be fragmented, a key facilitator was encouragement from healthcare professionals. Conclusion Our findings suggest that patients and healthcare professionals perceive patient-held medication lists to have a wide variety of benefits. Interventions are needed to raise awareness of the potential role of these lists in enhancing patient safety. Such interventions should empower patients and carers to identify a method that suits them best from a range of options and avoid a 'one size fits all' approach.