Risk-Informed Interventions in Community Pharmacy: Implementation and Evaluation

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；walgreens、Kerr Drug、Medicine Shoppe和Massachusetts General Hospital的门诊药房等社区药房实践站点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，通过风险知情干预提高社区药房的用药安全性。我们计划实施三种干预措施，因为在对四种高度警戒药物（waFOArin、芬太尼贴片、甲氨蝶呤和胰岛素）的分配建模时发现了显著的漏洞。简而言之，我们预测芬太尼贴片的处方错误和所有药物的订单输入错误经常到达消费者手中，每1000张处方中就有1张。在我们的风险模型中，各种干预措施的模拟导致了开发、测试和实施以下干预措施的决定：1)对所有处方waoarin、芬太尼贴片、甲氨蝶呤（MTX）和靶向胰岛素的消费者实施强制性的药剂师患者咨询；这是一项评估前和评估后的研究，使用观察和自我报告的数据来衡量干预措施的预防错误和检测频率；2)进行准备情况评估，为在社区药房实施条形码技术做准备；本研究采用前测和后测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)基于药房调剂过程的ST-PRA模型，对高警示药品实施简化的风险评估/风险干预计分卡工具；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，并提供干预措施的“菜单”（例如，“如果（风险因素）（增加/减少）___ %，错误到达患者的风险将减少到___ %”），该菜单将描述实施干预后预测发生的风险降低百分比。

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.