Assessing Risk in Ambulatory Medication Use after Hospital Transitions

描述(由申请人提供)：这项拟议的职业发展奖的目的是支持普通内科医生托莎·韦特内克博士建立一个研究计划，旨在提高从医院到初级保健过渡期间患者护理的安全性。该奖项将促进韦特内克博士在人类因素工程技术方面获得先进的研究能力，并为个人和团体提供个人和团队指导，这些研究人员具有指导内科科学家的良好记录。威斯康星大学麦迪逊分校为拟议的工作提供了理想的环境，因为它拥有强大的工业和系统工程、人口健康科学和医学系，已经建立的部门间合作以及医疗保健系统工程的悠久历史 研究。护理过渡越来越常见，是由于信息交换失败而导致的差错和患者伤害的来源。在这一培训拨款期间，韦特内克博士将进行研究，长期目标是确定从医院到初级保健过渡期间最安全的药物信息流程，以便为干预策略提供信息，通过防止错误并支持检测和纠正确实发生的错误来降低患者伤害的可能性。重要的是，这项研究是从初级保健提供者的角度进行的。为了确定干预策略，必须通过前瞻性风险评估来识别系统风险。风险评估必须考虑组织、环境、人(临床医生和病人)、技术和工具以及执行的任务的贡献。我们建议使用药品信息管理流程的故障模式和影响分析以及故障树分析来评估系统风险。我们还建议确定在医院过渡期间确实发生的错误被检测和纠正的机制--错误恢复过程。这一确定错误风险和恢复的补充办法将导致发展强有力的护理系统，既防止错误发生，又从确实发生的错误中恢复过来。

Description (provided by the applicant): The purpose of this proposed career development award is to support Dr. Tosha Wetterneck, a general internal medicine physician, in establishing a research program that seeks to improve the safety of patient care during transitions from hospital to primary care. This award will facilitate Dr. Wetterneck's acquisition of advanced research competencies in human factors engineering techniques and provide for individual and group mentoring from accomplished researchers with a proven track record of mentoring physician scientists. The University of Wisconsin-Madison offers an ideal environment for the proposed work because of the strong Departments of Industrial and Systems Engineering, Population Health Sciences and Medicine, the established interdepartmental collaborations and the long history of healthcare systems engineering research. Transitions of care are increasingly common and are a source of errors and patient harm due to failures in information exchange. During the period of this training grant, Dr. Wetterneck will conduct research in which the long-term goal is to determine the safest medication information process during transitions of care from hospital to primary care to inform intervention strategies that reduce the potential for patient harm by preventing errors and supporting the detection and correction of the errors that do occur. Importantly, this research is performed from the primary care provider perspective. In order to determine intervention strategies, it is imperative that the system risks are identified through prospective risk assessment. The risk assessment must consider the contributions of the organization, environment humans (clinician and patient), technology and tools and the tasks performed. We propose to use failure modes and effects analysis and fault tree analysis of the medication information management process to assess system risks. We also propose to identify the mechanisms by which errors that do occur during hospital transitions are detected and corrected - the process of error recovery. This complementary approach to identify error risks and recovery will lead to the development of robust systems of care that both prevent errors from occurring and recover from the errors that do occur.