Risk-Informed Interventions in Community Pharmacy: Implementation and Evaluation

描述(由申请人提供)：安全用药实践研究所(ISMP)；其合作伙伴、结果工程顾问；以及社区药房实践网站-Walgreens、Kerr Drug、Medicine Shoppe和马萨诸塞州综合医院门诊护理药房-计划应用从十几个详细的社会技术概率风险评估(ST-PRA)模型中学到的知识，通过风险知情干预提高社区药房的用药安全性。我们计划实施三种干预措施，这些干预措施是由于在对四种高警戒药物：wafoarin、芬太尼贴片、甲氨蝶呤和胰岛素的分配建模时检测到的重大漏洞而选择的。简而言之，我们预测，芬太尼贴片的处方错误和所有药物的订单输入错误都会频繁地到达消费者手中，高达每1000张处方中就有1张。在我们的风险模型中对各种干预措施的模拟导致了开发、测试和实施以下干预措施的决定：1)由药剂师对所有拿到wafoarin、芬太尼贴片、甲氨蝶呤(MTX)和目标类型胰岛素的处方的消费者进行强制性患者咨询；这是一项使用观察和自我报告的数据来衡量干预措施的差错预防和检测频率的前后评估研究；2)进行准备情况评估，为在社区药店实施条形码技术做准备；这项研究使用前测和后测设计来收集关于该工具预测和预防与条形码扫描相关的技术问题的能力的自我报告数据；以及3)基于药房配药过程的ST-PRA模型，针对高警戒药物实施简化的风险评估/风险干预记分卡工具；这项描述性研究将为社区药房提供一种方法，用于在定量测量中预测配药过程的当前风险，并提供干预“菜单”(例如，“如果(风险因素)增加/减少_%，则误差到达患者的风险将减少到_%”)，该方法将描述实施干预后预计发生的风险降低的百分比。 与公共健康相关：这项研究将有助于减少高警戒药物的有害处方、配药和自我给药错误--当错误发生时，这种药物造成伤害的风险最大。计划中的干预措施将增加消费者对与这些药物相关的风险的了解，从而挽救生命并限制与治疗有害用药错误相关的成本。这项研究还将促进条形码技术在社区药店的成功采用，并为药剂师提供一种新的工具，以预测用药错误的风险，以及最有效地降低这些风险的干预措施。

DESCRIPTION (provided by applicant): The Institute for Safe Medication Practices (ISMP); its partners, Outcome Engineering consultants; and community pharmacy practice sites-Walgreens, Kerr Drug, Medicine Shoppe, and Massachusetts General Hospital ambulatory care pharmacies-plan to apply what has been learned from more than a dozen detailed socio-technical probabilistic risk assessment (ST-PRA) models to improve medication safety in community pharmacies through risk informed interventions. We plan to implement three Interventions that were selected because of significant vulnerabilities detected when modeling the dispensing of four high-alert medications: waFOArin, fentanyl patches, methotrexate, and insulin. In brief, we predicted that prescribing errors with fentanyl patches and order entry errors for all drugs reach consumers frequently, as much as 1 per 1,000 prescriptions. Simulations of various interventions in our risk models led to the decision to develop, test, and implement the following interventions: 1) Implement mandatory patient counseling by a pharmacist for all consumers who pick up a prescription for waFOArin, fentanyl patches, methotrexate (MTX), and targeted types of insulin; this is a pre- and post-evaluation study using observational and self-reported data to measure the error-prevention and detection frequency of the intervention; 2) Conduct a readiness assessment to prepare for implementation of bar-coding technology in community pharmacies; this study uses a pretest and posttest design to gather self-reported data about the ability of the tool to predict and prevent technology problems related to barcode scanning; and 3) Implement the use of a simplified risk-assessment/risk-intervention scorecard tool for high-alert medications based on ST-PRA models of the pharmacy dispensing process; this descriptive study will offer community pharmacies a method for predicting the current risk, in quantitative measures, of the dispensing process and a "menu" of Interventions (e.g., "If (risk factor) is (increased/decreased) by ___ percent, risk that the error will reach the patient is reduced to ___ percent") that will describe the percent of risk reduction predicted to occur after implementing the intervention. PUBLIC HEALTH RELEVANCE: This study will help to reduce harmful prescribing, dispensing, and self-administration errors with high-alert medications-drugs that have the greatest risk of causing harm when a mistake occurs. The planned interventions will increase consumer knowledge of risks associated with these drugs, thus saving lives and limiting costs associated with the treatment of harmful medication errors. The study also will facilitate successful adoption of bar-coding technology in community pharmacies, as well as offer pharmacists a new tool to predict the risk of a medication error and the interventions that will be most effective in reducing these risks.