Improving Medication Management in Ambulatory Care

描述（由申请人提供）：在门诊环境中提供安全护理至关重要，因为那里提供的护理量很大。在任何一个月里，美国几乎有四分之一的人在门诊就医，而住院的人不到1%。导致患者伤害的错误在门诊环境中发生，用药错误的伤害风险最高。我们建议改善科罗拉多大学医院门诊护理诊所的安全文化，使用错误的药物管理作为学习基板。具体而言，我们将寻求改善：1）慢性药物监测，特别是实验室监测，2）药物核对和3）及时审查监测结果。我们将评估使用范围，有效性，经济性，采用，实施和维护（RE-AIM）模型开发的干预措施的有效性和可持续性。我们将制作一个传播工具包和一个传播我们调查结果的计划。我们的主要目标是促进识别，开发，测试和实施一系列干预措施的过程，以改善药物管理，最终目标是变更过程将成为我们机构提高门诊患者安全性的标准方法，无论目标变更或问题类型如何。在这个项目完成后，我们将完善干预过程，实践水平的变化过程，并开发了一个工具包，其他机构和门诊实践可以使用它来识别，开发，测试和实施安全的药物管理实践在门诊护理设置。 公共卫生相关性：改善门诊药物监测项目旨在改善科罗拉多大学医院门诊系统的安全和药物监测活动文化，同时引入可持续的质量和安全改进模式。

DESCRIPTION (provided by applicant): Providing safe care in the ambulatory setting is vitally important because of the sheer magnitude of care provided there. In any given month almost a quarter of people in the United States visit a physician in the ambulatory setting, compared to less than 1% that spend time as inpatients. Errors that lead to patient harm are well documented to occur in the ambulatory setting with medication errors having he highest risk for harm. We propose to improve the safety culture of the ambulatory care clinics of University of Colorado Hospital using errors in medication management as the learning substrate. Specifically, we will seek to improve: 1) chronic medication monitoring, particularly laboratory monitoring, 2) medication reconciliation and 3) timely review of monitoring results. We will evaluate the effectiveness and sustainability of the interventions developed using the Reach, Effectiveness, Economics, Adoption, Implementation and Maintenance (RE-AIM) model. We will create a tool kit for dissemination and a plan for dissemination of our findings. Our main thrust will be to facilitate the process of identifying, developing, testing, and implementing a series of interventions to improve medication management with the ultimate goal that the change process will become our institution's standard method of improving ambulatory patient safety, regardless of the targeted change or problem type. At the completion of this project, we will have refined the intervention processes, the practice level change processes and developed a toolkit that other institutions and ambulatory practices can use to identify, develop, test, and implement safe medication management practices in ambulatory care settings. PUBLIC HEALTH RELEVANCE: The Improving Ambulatory Medication Monitoring project is designed to improve the culture of safety and medication monitoring activities in the University of Colorado Hospital Ambulatory system while introducing a sustainable quality and safety improvement model.