Engineering Resilient Community Pharmacies (ENRICH)

项目总结/摘要 患有复杂慢性健康状况的人的增加给美国的医疗保健系统带来了压力。 需要慢性病护理管理（CCM）的人面临药物安全问题和健康的高风险- 相关伤害，如住院和急诊。社区药房发挥作用 在确保患者安全使用CCM药物方面， 其他制度障碍。为了防止需要CCM的人的药物危害，药房工作人员 进一步阻碍了历史的关注是什么“出了问题”（一个安全-我的方法），而不是 也考虑到绝大多数情况下事情“顺利”（安全-II方法）。本项目谋求 重新设计药房系统，以推进安全I和安全II相结合的方法来改善CCM。 我们的跨学科团队药剂师，卫生服务研究人员，工程师和定量和 定性研究人员将与两家大型医疗保健组织（Advocate Health，UW）的药房合作 健康），和博斯科贝尔和中心独立药房，设计和评估药房工作系统 最大限度地提高恢复力。为了实现这一目标，我们将创建药物安全地图 （MedSafeMap），以便药剂师和技术人员更好地导航复杂的药房任务，并促进 与患者和临床医生沟通，同时安全地为CCM患者提供药物。 CARE（应用弹性工程的概念）和SEIPS（系统工程倡议， 患者安全）模型将用于定义和解决复杂的药房工作系统问题， 加剧了需要CCM的患者的药物安全风险。人为因素和系统工程将是 用于执行AHRQ RFA要求的5步法。目标1将侧重于工作的问题分析 系统通过药剂师和技术人员利益相关者的观察和访谈，以及工作分析 系统信息流和工件，它们将说明 然后在目标2和3中加以处理。目标2将采用参与式设计和现场模拟， 设计MedSafeMap，详细说明药房重新设计建议，以优化药剂师和技术人员 在他们的工作系统中以及与患者/护理人员的互动。对于目标3，我们将实施和评估 MedSafeMap对CARE/SEIPS弹性结果的影响-药房工作人员的态度，行为，表现， 和工作要求（访谈和调查），任务所涉及的时间（时间和动作分析），类型和 提供的服务数量，以及与药物有关的问题的变化（自我报告的数据）。 这种创新的跨学科PSLL旨在重新设计互动，以加强药房员工的弹性 同时最终提高需要CCM的患者的用药安全性。因此，这项研究回应了一个 AHRQ优先人口（即，慢性病患者）和患者安全优先“，以检查有效的 进行系统级更改的方法，以帮助防止跨越药物使用过程连续体的错误。

Project Summary/Abstract The increase of people with complex chronic health conditions is stressing the U.S. healthcare delivery system. People needing chronic care management (CCM) are at a high risk of medication safety issues and health- related harms, such as hospitalizations and emergency department visits. Community pharmacies play a role in ensuring patients’ safe medication use for CCM, but their efforts are undermined by volatile work demands and other system barriers. In preventing medication hazards for people needing CCM, pharmacy staff are further hampered by the historical preoccupation with what “went wrong” (a Safety-I approach), rather than also considering the vast majority of times that things “go right” (a Safety-II approach). This project seeks to reengineer the pharmacy system to advance a combined Safety-I and Safety-II approach to improve CCM. Our transdisciplinary team of pharmacists, health services researchers, engineers, and quantitative and qualitative researchers will partner with pharmacies in 2 large healthcare organizations (Advocate Health, UW Health), and Boscobel and Center independent pharmacies, to design and evaluate a pharmacy work system of care that optimizes resilience. To achieve this objective, we will create the Medication Safety Map (MedSafeMap) for pharmacists and technicians to better navigate complex pharmacy tasks, and to facilitate communication with patients and clinicians, while safely providing medications for patients dealing with CCM. The CARE (Concepts for Applying Resilience Engineering) and SEIPS (Systems Engineering Initiative for Patient Safety) models will be used to define and address the complex pharmacy work system issues that exacerbate medication safety risks for patients needing CCM. Human factors and systems engineering will be used to carry out the AHRQ RFA-required 5-step method. Aim 1 will focus on problem analysis of the work system through pharmacist and technician stakeholder observations and interviews, and analyses of work system information flow and artifacts, which will illustrate relationships among work system features that are then addressed in Aims 2 and 3. Aim 2 will employ participatory design and in-situ simulations to develop and design MedSafeMap detailing pharmacy redesign recommendations to optimize pharmacist and technician interactions within their work system and with patients/caregivers. For Aim 3, we will implement and evaluate MedSafeMap impact on CARE/SEIPS resilience outcomes – pharmacy staff attitudes, behaviors, performance, and work demands (interviews and surveys), time involved in tasks (time and motion analysis), types and quantities of services provided, and perceived changes in medication-related problems (self-reported data). This innovative transdisciplinary PSLL seeks to redesign interactions to strengthen pharmacy staff resilience while ultimately improving medication safety for patients needing CCM. This study, therefore, responds to an AHRQ priority population (i.e., patients with chronic disease) and a patient safety priority “to examine effective ways to make system-level changes to help prevent errors” that span the medication use process continuum.