PROMIS Learning Lab: Partnership in Resilience for Medication Safety

我们建议为初级保健中的患者安全创建一个学习实验室。中国的伙伴关系 药物安全弹性学习实验室(PROMIS实验室)重新设计初级保健工作系统，以解决 通过与诊所和患者合作，在老年人中产生多种与药物相关的伤害， 包括那些社会经济地位较低的人。可预防的阿片类药物对患者的伤害包括 在门诊和社区环境中对患者安全构成重大威胁，并促成了700,000起紧急情况 每年都有部门来访。超过三分之一的65岁或65岁以上的社区居民居住5岁或更长时间 处方药。在门诊和社区环境中，比在住院环境中更是如此，药物治疗 安全是由患者/家人和不同地点的不同专业人员之间的互动决定的。这个 PROMIS实验室在初级保健领域开发了亟需的战略，专业人员在这方面处于独特的地位 与患者和社区护理人员合作，降低与药物相关的可预防伤害的风险，如 作为多药和不准确的用药信息，并应对挫折和干扰 威胁到安全。我们的团队处于独特的地位，可以采用系统工程的方法来建立合作伙伴关系。 我们将与来自基于实践的研究网络的两个“现场实验室”诊所合作，以进行问题分析、设计 和评估。Promis实验室包括社区合作伙伴，让老年人和他们的照顾者参与 设计周期，以及提供信息的诊所网络，以供观察和学习。我们将进行设计和 测试一个模拟的门诊护理套间。病人和家庭照顾者经常遇到困扰 由医疗体制、社区、家庭、患者等因素诱发。Promis实验室在以下方面创新解决方案 通过专注于增强采取弹性行动的能力，在开放的社区环境中确保患者安全 动态预防、缓解和恢复失败并在药物安全方面取得成功 社区设置。我们将使用众所周知的系统工程方法来实现其目标：问题 分析(目标1)、设计和开发(目标2)、实施和评价(目标3)。目标#1.确定和 定义初级保健工作系统设计要求，以解决常见的药物相关问题 安全风险，并通过伙伴关系实现有弹性的业绩。目标#2.提高初级教育的价值 使用工作系统设计策略的护理服务，如信息工具、任务重新设计和空间 布局，以实现和构建具有弹性的性能。目标3.实施和评估重新设计工作 2个初级保健诊所的系统组件。Promis实验室的长期影响将是洞察力和 创新而又实用的工具、设计指南和协作支持战略，使团队合作超越 诊所墙，有效地与临床医生、药剂师、患者和家属合作，减少不适当的情况 阿片类药物的使用和其他常见的高风险危险用药做法。我们的目标是对医疗保健的弹性 弱势人群的分娩挑战以及护理他们的临床医生。

We propose to create a learning laboratory for patient safety in primary care. The Partnership in Resilience for Medication Safety Learning Lab (PROMIS Lab) redesigns primary care work systems to address multiple types of medication related harms among older adults through collaborating with clinics and patients, including those in low socio-economic status. Preventable patient harms from medications such as opioids are significant threats to patient safety in ambulatory and community settings and contributed 700,000 emergency department visits each year. More than a third of community-dwelling 65 years or older adults take 5 or more prescription medications. In ambulatory and community settings, more so than in inpatient settings, medication safety is shaped by interactions among patient/family and different professionals across locations. The PROMIS Lab develops much needed strategies in primary care where professionals are in a unique position to partner with patients and community caregivers to reduce risks of medication-related preventable harms, such as polypharmacy and inaccurate medication information, and to cope with setbacks and disturbances that threaten safety. Our team is uniquely positioned to take systems engineering approach to partnership building. We will work with two “in-situ lab” clinics from a practice-based research network for problem analysis, design and evaluation. The PROMIS Lab includes community partners to involve older adults and their caregivers in design cycles, and a network of informant clinics for observations and learning. We will conduct design and tests a simulated outpatient care suite. Patients and home caregivers frequently encounter disturbances induced by healthcare system, community, family and patient factors. The PROMIS Lab innovates solutions in patient safety in an “open” community environment by focusing on enhancing capacity for resilient actions to dynamically forestall, mitigate, and recover from failures and in achieving success in medication safety in community settings. We will use the well-known systems engineering approach to achieve its goals: problem analysis (Aim1), design and development (Aim 2), implementation and evaluation (Aim 3). Aim #1. Identify and define primary care work system design requirements to address commonly occurring medication related safety hazards and to enable resilient performance through partnership. Aim #2. Improve the value of primary care services using work system design strategies, such as informational tools, task redesign, and space layout, to enable and build capacity for resilient performance. Aim #3. Implement and evaluate redesign work system components at 2 primary care clinics. The PROMIS Lab's long term impact will be insights and innovative, yet practical tools, design guidelines, and collaboration support strategies for teamwork beyond clinic walls, to effectively partner with clinicians, pharmacists, patients and families to reduce inappropriate opioid use and other common high-risk dangerous medication practices. We aim at resilience to health care delivery challenges in vulnerable populations and the clinicians caring for them.