تجزیه و تحلیل فرآیند محور تجویز دارو : شناسایی روش های فعلی و بالقوه برای بهبود

Medication administration is an increasingly complex process that requires adaptability by nurses. In this study, twenty-one observational sessions of the medication administration process were conducted on a Medical/Surgical unit, and the processes used by nurses were analyzed to discover systemic process variability and determine possible best practices. When nurses instituted a patient medication order and medication review cycle prior to the other activities associated with medication administration, it was more likely that discrepancies in physician orders, electronic medication administration records, and missing medications would be mitigated within the same medication pass.

Medication administration is an ever more complex process influenced by the number of medications on the market, the number of medications prescribed for each patient, use of electronic technologies, facility design, and the numerous policies and procedures that govern control and administration. Most of the research to date has focused on the causes of medication errors without examining the underlying processes involved in the administration of the medication (Cohen, 2007 and Institute of Medicine, 2007). Current medication administration processes involve many tasks, including but not limited to, assessing the patient to obtain pertinent data, confirming the five rights (right dose, right patient, right route, right medication, and the right time), gathering medications, administering the medications at the point of service to patients, and documenting administration while maintaining care and observing for side effects. It is necessary to understand the complexity involved in both the pharmacists’ and nurses’ processes and workflow to develop better safeguards and robust systems that reduce the probability of errors and adverse events. Therefore, this study focused on documenting the medication administration processes of nurses at one satellite hospital of a multi-hospital center to determine the level of process standardization among nurses, as well as to identify which tasks could benefit from process improvement given the constraints of the system. This investigation contributes to the literature on medication administration by being among the first to describe in detail the process workflows and variations employed by different nurses on one nursing unit. It adds to the work by Elganzouri et al. (2009) by expanding the common categories of tasks performed by nurses administering medications from four to eight, which facilitates better description of tasks and variations.

Previous medication administration research has evaluated nursing time involved in medication administration processes compared to other responsibilities, identi fi ed different macro-componentsoftheprocess,thenumberofinterruptionsthatdistract attentionandincreasethelikelihoodoferror,nursetraveldistances, speci fi c technology components, and other factors that in fl uence safety and ef fi ciency. However, this is the fi rst study known to examine and diagram in detail the process variations among nurses used to deliver medications on one unit, and to analyze these vari- ations in terms of ef fi ciency. These fi ndings have shown that it is important to maintain fl exibility within the medication adminis- tration process while standardizing best practices because of the highly dynamic nature of the work environment and rapidly changing conditions of patients. For best practices to be set, one must also consider the goals of the hospital in terms of patient satisfaction and time ef fi ciency. In general, incorporating a cycle to review patient medication orders, ensuring the completeness of all paperwork,andverifyingthattheorderedmedicationsareavailable (ofthosestoredinthemedicationdrawer)seemedtohaveapositive effectonthemedicationadministrationroundsobserved.Whilethis isnotnecessarilyapparentfromthecompletiontimesofmedication administration, the impact of delays was reduced in observations including these practices. When comparing these fi ndings to those of other studies, it became apparent that the layout of the patient unit and resources are factors that signi fi cantly in fl uence results and therefore should be included in any description of the research context. Also, the differences in data collected by engineers compared to nurses, suggest the importance of involving engineers in developing and testing data collection instruments, collecting data, and analyzing fi ndings. Their perspective is vital to observing and developing processes that are both safe and ef fi cient, as well as feasible for nurses to use in view of other competing responsibilities. As more research is conducted it will be important to gain a better understanding of the interaction between pharmacy and nursing processes involved in medication administration and to standardize categories of activities to be examined as well as de fi nitions of terms, such as the various types of interruptions, errors, etc. so that results can be compared and the evidence of best practices developed.