기타학회
| Development of a Standard Prescription Supporting Program for High-Alert Parenteral Medications to Improve Patient Safety | ||
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Department of Pharmacy, Asan Medical Center, South Korea
Introduction Pharmacist-led improvement of prescribing programs is the most advanced form of hospital pharmacists' medication management. In terms of medication management, pharmacists should focus on high-alert medications, which have a high risk of causing significant harm when used in error. The pharmacy & therapeutics (P&T) committee of Asan medical center had established a standard guideline for prescribing high-alert medications, but there were still non-standard prescriptions and communication errors, which could threaten patient safety. As the need for a more proactive process increased, we developed an order entry system to support standardized prescribing of high-alert medications.
Method An analysis of prescription patterns was followed by the implementation of a new order entry system. All prescriptions of high-alert parenteral medications outside of the standard guideline were collected and assessed. If the prescriptions were suitable for standardization, they were adopted as standard prescriptions. Unless, we communicated with the medical staff and requested them to follow the guideline. Based on the data, we established a new standard guideline for prescribing high-alert parenteral medications and developed a standard prescription supporting program. To raise awareness among physicians and nurses, the guideline was announced throughout the hospital. The new prescribing system recommended regimens, including a standardized dosage, dosing interval, and infusion rate for each route of administration. The standard regimens were managed by pharmacists using an electronic database, and each regimen was approved by the P&T committee.
Results Seventy-six standard regimens for adults were created for seventeen ingredients of high-alert medications. Forty-four intravenous infusion regimens were developed, including thirty continuous intravenous infusion regimens. Following the implementation of the standard prescription supporting program, the incidence of prescriptions with incorrect dosing intervals or routes dramatically decreased from 23.2% to 0.136%. Additionally, continuous infusion orders missing infusion rates had been common (24.3%), but they were not prescribed at all under the new prescription program. The introduction of the new order entry system, which recommended compatible infusion fluids and concentrations, also led to a reduction in prescriptions with dilution errors from 1.0% to 0%. Furthermore, the standardized orders with detailed and accurate directions resulted in a decrease in medication administration errors by nurses.
Conclusion The development and implementation of a standard prescription supporting program allowed a tertiary hospital to enforce the standardized use of high-alert medications and prevent medication errors by enhancing communication. These findings highlight the valuable contribution of pharmacist-led medication management to patient safety. |
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