Risk-Informed Interventions in Community Pharmacy: Implementation and Evaluation

社区药房的风险知情干预措施：实施和评估

• 批准号: 7943101
• 负责人: Michael R Cohen
• 金额: $ 11.44万
• 依托单位: INSTITUTE FOR SAFE MEDICATION PRACTICES
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-30 至 2012-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7943101
• 关键词: Risk; Informed; Interventions; Community; Pharmacy

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.

描述（由申请人提供）：安全用药实践研究所（ISMP）;其合作伙伴，成果工程顾问;和社区药房实践网站-沃尔格林，克尔药品，医药商店，和马萨诸塞州总医院门诊护理药房-计划应用从十几个详细的社会技术概率风险评估（ST-PRA）中学到的东西通过风险知情的干预措施提高社区药房的药物安全性的模式。我们计划实施三种干预措施，这三种干预措施是因为在对四种高警戒药物（waFOArin、芬太尼贴剂、甲氨蝶呤和胰岛素）的分配进行建模时检测到了重大漏洞而选择的。简而言之，我们预测，芬太尼贴剂的处方错误和所有药物的订单输入错误经常出现在消费者身上，每1,000张处方中就有1张。在我们的风险模型中模拟各种干预措施，导致决定开发、测试和实施以下干预措施：1）由药剂师对所有购买waFOArin、芬太尼贴剂、甲氨蝶呤（MTX）和靶向类型胰岛素处方的消费者实施强制性患者咨询;这是一项评估前和评估后研究，利用观察和自我报告的数据来衡量干预措施的防错和发现频率; 2）进行准备评估，为社区药店实施条形码技术做准备;本研究采用前测和后测设计，收集有关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）根据药房配药流程的ST-PRA模型，对高度警戒药物使用简化的风险评估/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预测当前风险的方法，以定量方式，和干预的“菜单”（例如，“如果（风险因素）（增加/减少）_ %，则错误到达患者的风险降低至_ %”），该风险将描述实施干预后预计发生的风险降低百分比。 公共卫生相关性：这项研究将有助于减少有害的处方，配药，和自我管理的高度警惕的药物错误，药物有最大的风险，造成伤害时，错误发生。计划中的干预措施将增加消费者对这些药物相关风险的了解，从而挽救生命并限制与治疗有害用药错误相关的成本。该研究还将促进社区药店成功采用条形码技术，并为药剂师提供一种新的工具来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。