A Systems Approach to Improve Safe Medication Management for Children with Medical Complexity

项目摘要 拟议的研究解决了具有医学复杂性（CMC）的儿童中的关键患者安全差距 在医院和家庭用药相关伤害之间过渡。CMC往往是在多个和复杂的 药物治疗方案，并有密集的医疗保健需求。因此，他们经常经历 护理，跨专业角色和护理环境，并在这些过渡，CMC是在很大的风险， 与药物有关的伤害。大多数过渡性护理干预措施是从成人护理机构中采取的， 可能不足以满足CMC及其家庭护理人员的独特需求。的干预措施 需要基于这些患者的独特情况和复杂性来改善药物使用 安全和家庭护理经验。 本提案描述了PI通过发展以下专业知识过渡为独立研究者的计划： 1)参与式的、以人为本的设计，共同制定有用的干预措施; 2）实施和 评估干预措施。该提案还描述了一个为期4年的项目，以开发一个原型护理 过渡用药安全性干预，并生成有关其可用性和潜在因素的早期证据 影响其未来的实施。 目标1：患者旅程映射-将用于阐明药物安全风险和背景， 从医院到家庭的过渡期将使用行程图来捕获和直观地表示药物 利用家庭的经验跨越专业设置和界限。这一目标的产出将告知 Aim 2下的原型设计。 目的2：以人为本的前瞻性设计，共同设计原型药物安全干预。通过 多个，迭代的共同设计会议涉及医疗保健工作者和家庭护理人员，一个团队将设计一个 原型药物安全干预由目标1、当前文献和 参与者的启发。其结果将是一个复合原型准备可用性测试。 目标3：将测试原型干预与医护人员和家庭护理人员的可用性。此外，本发明还 将探讨在今后原型实施过程中可能遇到的障碍和促进因素。采取 所有这三个目标将共同产生一个最终的、改进的原型干预措施，旨在提高药物使用安全性 在护理过渡期间。 未来的工作将包括一个原型药物安全干预的随机对照试验， 正式评估其在预防或减少药物相关伤害以及改善 CMC及其家庭照顾者的药物使用经验。

PROJECT SUMMARY The proposed research addresses a key patient safety gap among children with medical complexity (CMC) transitioning between hospital and home—medication related harm. CMC are often on multiple and complex medication regimens and have intensive healthcare needs. As a result, they experience frequent transitions of care, across professional roles and care settings and during these transitions, CMC are at great risk for medication-related harm. Most transitional care interventions have been adopted from adult care settings and may not be adequate to address the unique needs of CMC and their family caregivers. Interventions that are grounded in the unique situations and complexities of such patients are needed to improve medication use safety and family experience of care. This proposal describes the PI’s plan to transition into an independent investigator by developing expertise in 1) participatory, human centered design to co-develop useful interventions, and 2) implementing and evaluating interventions. The proposal also describes a 4-year project for developing a prototype care transition medication safety intervention and generating early evidence on its usability and potential factors influencing its future implementation. Aim 1: Patient journey mapping—will be used to elucidate medication safety risks and contexts during the hospital-to-home transition period. Journey maps will be used to capture and visually represent the medication use experience of families across professional settings and boundaries. The output of this aim will inform prototype design under Aim 2. Aim 2: Participatory, human centered design to co-design a prototype medication safety intervention. Through multiple, iterative co-design sessions involving healthcare workers and family caregivers, a team will design a prototype medication safety intervention informed by journey maps from Aim 1, current literature, and participant elicitations. The result will be a composite prototype ready for usability testing. Aim 3: Will test usability of prototype intervention with healthcare workers and family caregivers. Additionally, barriers and facilitators that may be anticipated during future prototype implementation will be explored. Taken together, all 3 aims will yield a final, refined prototype intervention designed to improve medication use safety during care transitions. Future work will include a randomized controlled trial of the prototype medication safety intervention to formally evaluate it effectiveness in preventing or reducing medication related harm as well as improving the medication use experience of CMC and their family caregivers.