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: 7692274
• 负责人: Michael R Cohen
• 金额: $ 29.59万
• 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 2011-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7692274
• 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；沃尔格林 (Walgreens)、克尔药房 (Kerr Drug)、Medicine Shoppe 和马萨诸塞州总医院门诊药房等社区药房实践场所计划应用从十多个详细的社会技术概率风险评估 (ST-PRA) 模型中学到的知识，通过风险知情干预措施提高社区药房的用药安全性。我们计划实施三项干预措施，因为在对四种高度警戒药物的配药进行建模时发现了重大漏洞：waFOArin、芬太尼贴剂、甲氨蝶呤和胰岛素。简而言之，我们预测消费者经常会出现芬太尼贴剂处方错误和所有药物的订单输入错误，每 1,000 个处方中就会有多达 1 个。在我们的风险模型中对各种干预措施进行模拟后，我们决定开发、测试和实施以下干预措施： 1) 由药剂师对所有拿到华福林、芬太尼贴剂、甲氨蝶呤 (MTX) 和目标类型胰岛素处方的消费者实施强制性患者咨询；这是一项事前和事后评估研究，使用观察和自我报告数据来衡量干预措施的错误预防和检测频率； 2) 进行准备情况评估，为社区药房实施条码技术做好准备；本研究采用预测试和后测试设计来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； 3) 基于药房配药流程的 ST-PRA 模型，对高度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定量预测配药过程当前风险的方法和干预“菜单”（例如，“如果（风险因素）（增加/减少）___%，则错误到达患者的风险将降低至 ___%”），该“菜单”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高度警惕药物的有害处方、配药和自我给药错误，这些药物在发生错误时造成伤害的风险最大。计划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房成功采用条形码技术，并为药剂师提供一种新工具来预测用药错误的风险以及最有效降低这些风险的干预措施。