PROMIS Learning Lab: Partnership in Resilience for Medication Safety

我们建议建立一个学习实验室，为病人的安全在初级保健。伙伴关系 药物安全学习实验室（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，在老年人中发现多种类型的药物相关危害， 包括社会经济地位低下的人。阿片类药物等药物对患者造成的伤害是可以接受的， 对门诊和社区环境中的患者安全构成重大威胁， 每年都有部门来访。超过三分之一的社区居住的65岁或以上的成年人服用5或更多 处方药在门诊和社区环境中，药物治疗比住院环境中更常见， 安全性是由患者/家属和不同地点的不同专业人员之间的相互作用决定的。的 PROMIS实验室开发急需的初级保健战略，专业人员处于独特的地位， 与患者和社区护理人员合作，以减少与药物相关的可预防伤害的风险， 作为多药和不准确的药物信息，并科普挫折和干扰， 威胁安全。我们的团队具有独特的优势，可以采用系统工程方法建立合作伙伴关系。 我们将与两个“原位实验室”诊所从一个基于实践的研究网络的问题分析，设计， 和评价。PROMIS实验室包括社区合作伙伴，让老年人及其照顾者参与 设计周期，以及观察和学习的信息提供者诊所网络。我们将进行设计， 测试一个模拟的门诊病人护理室患者和家庭护理人员经常遇到干扰 由医疗系统、社区、家庭和患者因素引起。PROMIS实验室创新解决方案， 在“开放”的社区环境中确保患者安全，重点是加强采取弹性行动的能力， 动态地预防，减轻和恢复失败，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： 分析（目标1）、设计和开发（目标2）、实施和评估（目标3）。目标1。识别和 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 安全隐患，并通过伙伴关系实现弹性性能。目标2。提高小学的价值 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，以实现和建设弹性性能的能力。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部件。PROMIS实验室的长期影响将是洞察力和 创新而实用的工具、设计指南和协作支持策略， 诊所墙壁，与临床医生、药剂师、患者和家庭有效合作，减少不适当的 阿片类药物的使用和其他常见的高风险危险药物的做法。我们的目标是对医疗保健的适应能力 在弱势群体和照顾他们的临床医生中的交付挑战。

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.