Medication Error Reduction, Technologies & Human Factor

减少用药错误，技术

• 批准号: 6805194
• 负责人: PASCALE CARAYON
• 金额: $ 19.04万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-30 至 2006-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6805194
• 关键词: automated data processing; behavioral /social science research tag; biotechnology; clinical research; health care personnel performance; health care quality; health care service evaluation; health services research tag; health surveys; human subject; job satisfaction; longitudinal human study; patient care management; patient safety /medical error; pharmacy administration; psychological stressor; self concept; automated data processing; behavioral /social science research tag; biotechnology; clinical research; health care personnel performance; health care quality; health care service evaluation; health services research tag; health surveys; human subject; job satisfaction; longitudinal human study; patient care management; patient safety /medical error; pharmacy administration; psychological stressor; self concept

DESCRIPTION (provided by applicant): Technology has been used to decrease medication errors throughout the medication use process. However, implementation of technology with a prospective approach using human factors techniques to smooth the transitions is not routinely used. Instead, failures in implementation and new errors have occurred. The medication administration process has few double checks in the process and new technology is available to decrease errors. Intravenous medication errors directly reach the patient and are among the most serious medication errors. Smart IV pumps have predefined medication dose limits and their integration with bar code technology may be the ultimate defense for infusion errors. This study proposes to evaluate the implementation of Smart IV pumps and their integration with a bar code medication administration system in a large University Hospital. The technologies have the ability to decrease medication administration errors and also change nurses' and other end users' worklife. For that reason, the human factors approach with prospective error analysis will be used to evaluate the technology and technology change process; specifically utilizing failure mode and effects analysis, work system analysis and technology change surveys to improve implementation. Direct observations, surveys and longitudinal assessment of the Smart IV pump event log data and error reports will provide rich data on IV pump programming errors and provider job and worklife characteristics affected by the change process. This study will provide hospitals without medication administration technology opportunities to assess and change human, medication and organizational factors related to pump programming errors. Valuable information will be gained and shared about the technology change process associated with Smart IV pump implementation and integration with a bar code medication administration system to allow other hospitals to safely and effectively implement these technologies and avert new errors.

描述（由申请人提供）：技术已用于在整个用药过程中减少用药错误。但是，使用人为因素技术来平滑过渡的技术实施技术的实施不常规。 相反，实施失败和新错误发生了。 药物管理过程在该过程中几乎没有进行双重检查，并且可以使用新技术来减少错误。 静脉药物错误直接到达患者，并且是最严重的药物错误。 Smart IV泵具有预定义的药物剂量限制，它们与条形码技术的集成可能是输注错误的最终防御。这项研究建议评估SMART IV泵的实施及其与大型大学医院中条形码药物管理系统的整合。这些技术具有减少药物管理错误的能力，还可以改变护士和其他最终用户的工作。因此，将使用前瞻性错误分析的人为因素来评估技术和技术变化过程。特别是利用故障模式和效果分析，工作系统分析和技术变更调查来改善实施。智能IV泵泵事件日志数据和错误报告的直接观察，调查和纵向评估将提供有关IV泵编程错误以及提供者的工作以及受变更过程影响的工作人员特征的丰富数据。这项研究将提供医院，而没有药物管理技术机会，可以评估和改变与泵计划错误有关的人类，药物和组织因素。关于与智能IV泵的实施和与条形码药物管理系统集成相关的技术变更过程的有价值信息，并可以允许其他医院安全有效地实施这些技术并避免新错误。