A Systems Approach to Improve Safe Medication Management for Children with Medical Complexity

项目总结 这项拟议的研究解决了患有医疗复杂性(CMC)儿童的一个关键的患者安全差距 在医院和家庭之间转换-与药物相关的伤害。CMC往往是多个和复杂的 药物治疗方案，并有密集的医疗保健需求。因此，他们经历了频繁的 护理，跨专业角色和护理设置，在这些过渡期间，CMC面临着极大的风险 与药物有关的伤害。大多数过渡性护理干预措施都是从成人护理环境中采取的， 可能不足以满足CMC及其家庭照顾者的独特需求。干预措施是 基于这类患者的独特情况和复杂性，需要改善药物使用 安全和家庭护理体验。 该提案描述了独立调查员的计划，即通过发展以下方面的专业知识来过渡到独立调查员 1)参与式、以人为中心的设计，以共同开发有用的干预措施；以及2)实施和 评估干预措施。该提案还描述了一个为期4年的开发原型护理的项目 过渡性用药安全干预及其可用性和潜在因素的早期证据 影响其未来的实施。 目标1：病人旅程图-将用于阐明用药安全风险和期间的背景 医院到家庭的过渡期。旅程地图将被用来捕捉和直观地表示药物 使用跨越专业设置和边界的家庭的经验。这一目标的结果将告知 目标2下的原型设计。 目的2：参与式、以人为中心的设计，共同设计一个药物安全干预的原型。穿过 包括医护人员和家庭护理人员在内的多个迭代联合设计会议，一个团队将设计 原型药物安全干预由Aim 1中的旅程地图、当前文献和 参与者启发。结果将是一个准备好进行可用性测试的复合原型。 目标3：将在医护人员和家庭照顾者中测试原型干预的可用性。另外， 将探讨在未来原型实施过程中可能遇到的障碍和促进者。已被占用 所有三个目标加在一起，将产生最终的、改进的原型干预措施，旨在提高药物使用的安全性 在护理过渡期间。 未来的工作将包括对原型药物安全干预进行随机对照试验，以 正式评估其在预防或减少与药物有关的伤害以及改善 CMC及其家属照顾者用药经历。

PROJECT SUMMARY The proposed research addresses a key patient safety gap among children with medical complexity (CMC) transitioning between hospital and home—medication related harm. CMC are often on multiple and complex medication regimens and have intensive healthcare needs. As a result, they experience frequent transitions of care, across professional roles and care settings and during these transitions, CMC are at great risk for medication-related harm. Most transitional care interventions have been adopted from adult care settings and may not be adequate to address the unique needs of CMC and their family caregivers. Interventions that are grounded in the unique situations and complexities of such patients are needed to improve medication use safety and family experience of care. This proposal describes the PI’s plan to transition into an independent investigator by developing expertise in 1) participatory, human centered design to co-develop useful interventions, and 2) implementing and evaluating interventions. The proposal also describes a 4-year project for developing a prototype care transition medication safety intervention and generating early evidence on its usability and potential factors influencing its future implementation. Aim 1: Patient journey mapping—will be used to elucidate medication safety risks and contexts during the hospital-to-home transition period. Journey maps will be used to capture and visually represent the medication use experience of families across professional settings and boundaries. The output of this aim will inform prototype design under Aim 2. Aim 2: Participatory, human centered design to co-design a prototype medication safety intervention. Through multiple, iterative co-design sessions involving healthcare workers and family caregivers, a team will design a prototype medication safety intervention informed by journey maps from Aim 1, current literature, and participant elicitations. The result will be a composite prototype ready for usability testing. Aim 3: Will test usability of prototype intervention with healthcare workers and family caregivers. Additionally, barriers and facilitators that may be anticipated during future prototype implementation will be explored. Taken together, all 3 aims will yield a final, refined prototype intervention designed to improve medication use safety during care transitions. Future work will include a randomized controlled trial of the prototype medication safety intervention to formally evaluate it effectiveness in preventing or reducing medication related harm as well as improving the medication use experience of CMC and their family caregivers.