Improving Medication Management in Ambulatory Care

描述(由申请人提供)：在门诊环境中提供安全护理是至关重要的，因为那里提供的护理规模非常大。在任何一个月，几乎四分之一的美国人在门诊就诊，相比之下，只有不到1%的人在住院期间就诊。导致患者伤害的差错有充分的证据表明发生在非卧床环境中，用药差错具有最高的伤害风险。我们建议改进科罗拉多大学医院门诊护理诊所的安全文化，将用药管理中的错误作为学习的基础。具体地说，我们将寻求改善：1)慢性药物监测，特别是实验室监测；2)药物调节；3)及时审查监测结果。我们将评估使用REACH、Efficiency、Economics、Adption、Implementation和Maintenance(RE-AIM)模式制定的干预措施的有效性和可持续性。我们将创建一个传播工具包和一个传播我们的调查结果的计划。我们的主旨将是促进识别、开发、测试和实施一系列干预措施的过程，以改善药物管理，最终目标是无论目标变化或问题类型如何，变化过程都将成为我们机构提高门诊患者安全性的标准方法。在这个项目完成后，我们将完善干预流程、实践水平变化流程，并开发了一个工具包，其他机构和门诊实践可以使用它来识别、开发、测试和实施门诊护理环境中的安全用药管理实践。 公共卫生相关性：改善门诊用药监测项目旨在改善科罗拉多大学医院门诊系统的安全文化和用药监测活动，同时引入可持续的质量和安全改进模式。

DESCRIPTION (provided by applicant): Providing safe care in the ambulatory setting is vitally important because of the sheer magnitude of care provided there. In any given month almost a quarter of people in the United States visit a physician in the ambulatory setting, compared to less than 1% that spend time as inpatients. Errors that lead to patient harm are well documented to occur in the ambulatory setting with medication errors having he highest risk for harm. We propose to improve the safety culture of the ambulatory care clinics of University of Colorado Hospital using errors in medication management as the learning substrate. Specifically, we will seek to improve: 1) chronic medication monitoring, particularly laboratory monitoring, 2) medication reconciliation and 3) timely review of monitoring results. We will evaluate the effectiveness and sustainability of the interventions developed using the Reach, Effectiveness, Economics, Adoption, Implementation and Maintenance (RE-AIM) model. We will create a tool kit for dissemination and a plan for dissemination of our findings. Our main thrust will be to facilitate the process of identifying, developing, testing, and implementing a series of interventions to improve medication management with the ultimate goal that the change process will become our institution's standard method of improving ambulatory patient safety, regardless of the targeted change or problem type. At the completion of this project, we will have refined the intervention processes, the practice level change processes and developed a toolkit that other institutions and ambulatory practices can use to identify, develop, test, and implement safe medication management practices in ambulatory care settings. PUBLIC HEALTH RELEVANCE: The Improving Ambulatory Medication Monitoring project is designed to improve the culture of safety and medication monitoring activities in the University of Colorado Hospital Ambulatory system while introducing a sustainable quality and safety improvement model.