This study is a methodological research to measure a current level associated with high-risk medication safety issues and derive key source parameters through selection of items with high possibility of potential improvements in the clinical field based on Donabedian (1966) Paradigm as a conceptual ...
This study is a methodological research to measure a current level associated with high-risk medication safety issues and derive key source parameters through selection of items with high possibility of potential improvements in the clinical field based on Donabedian (1966) Paradigm as a conceptual framework, thereby developing and managing medication safety guidelines. Research was conducted, targeting doctors, nurses and pharmacists working at university hospital located in D city, and improvement team composed of nurses with more than 4 year working experiences in the applicable department and business improvement activities on the recommendation of the appropriate department head participated in the overall improvement activities with researchers. For data analysis, Minitab 16 PC+ program was used, and general characteristics of subjects were analyzed through the frequency and percentage. For survey analysis on the implementation of medication safety targeting nurses, doctors and pharmacists, Pareto chart analysis and content analysis were carried out, and to analyze the level of performance and knowledge on the pre and post-medication safety of application of high-risk intravenous medication safety guidelines targeting nurses, the standard deviation and Wilcoxon rank sum test were conducted. In addition to these, cause and effect diagram, 4 block matrix and logic tree analysis were utilized. This study was proceeded through 3 areas of structure, process and result of Donabedian (1966). In the structural area, organization's internal capabilities and external environment were analyzed, and in the process area, evaluation was made using 5-step process by DMAIC process of 6 sigma techniques. In the result area, checklists, educational interventions and medication safety guidelines standardized through the process area were deduced, and the results are as follows. First, as a result of analysis on the cause of problems in high-risk intravenous medication safety, frequent oral prescription, interruption of the medication process, negligence in checking patients, fluid infusion and fluid speed control and incorrect infusion were pointed out as process causes, and in case of environmental causes, there were inexperience in infusion device operation, packaging confusion, improper medication administration, absence of medication procedures manual, inadequate storage and confusion of injection capacity units. As nurse causes, lack of awareness and knowledge about drugs, hurry practices, shortage of nursing staffs and lack of drug education targeting nurses were marked. Taking high possibility of the actual promotion and performance into consideration, development and standardization of high-risk intravenous medication safety guidelines for nurses was selected as final the challenge to promote. Second, from the result of analysis on the level of high-risk intravenous mediation safety prior knowledge/performance of nurses, it turned out that identification of prescription and drug capacity, situations exposed when handling anticancer drugs, records on the anticancer medication and nursing and observations of cancer treatment were deduced as improvement items of knowledge, and in performance, checking prescription up with drug capacity, identification of the validity of drug, checking the patients, safe management and storage of high-risk critical care medicine were analyzed as major improvement items. As a result of analysis on the NaCl/ KCl and Heparin medication process, a wide variety of medication safety issues ranging from 'frequent oral prescription' in prescribed medication verification process of nurses resulting in problems in understanding of medication and process of performing medication, checking the patients, patient dose assessment, implementation process of medication and side effects of drugs to periodic monitoring process were raised. Third, total of 11 key source items according to 5 major issues on the high-risk intravenous medication safety of nurses were analyzed, and as a result of the research targeting improvement team, absence of major drug medication protocol by wards, lack of education on operations of medication infusion device, non-establishment of a standardized procedure to perform high-risk intravenous medication, lack of personalized medication education targeting nurses, lack of drug booklet kept in hospitals and negligence in checking packaging drugs in the similar containers were drawn as key factors. And among them, 4 key sources were selected as final causes and they were reflected in the improvement plans. Fourth, as contents of high-risk intravenous medication safety improvements, standardized high-risk intravenous medication safety process and checklists were drawn up based on the medication safety guidelines established by supplementing GAP deduced as medication safety problems identified in the medication process, and as a final step, an education plan to complement deficiencies identified in the procedures by stages was developed and it was provided as the final improvement plan for educational performance targeting nurses. Fifth, management plan including measures in the event of problems, persons in charge, management methods and management indicators applicable to medication safety checklist, medication performance process and high-risk intravenous medication safety guidelines was made out, and as a final step for completion of 6 sigma project, the final report including titles of the current proceedings, major problems, improvement issues, quantitative and qualitative effects corresponding to promotion results was drawn up. This study was designed to develop medication safety guidelines reflecting organization's needs to improve human errors through application of system approach starting from analyzing the applicable organizations and identifying the problems for the purpose of improvement of patient safety and satisfaction, thereby contributing to solving the fundamental problems in the medication implementation process and maintenance of the solved problems. In the mean time, this study has its significance in that it suggested strategies to improve human factors and establish safety system of medical institutions for improvement of medication safety through activities to improve and identify problems of the structural systems so that full compliance of the developed medication safety guidelines can be achieved within nursing procedures and regulations of the medical institutions.
This study is a methodological research to measure a current level associated with high-risk medication safety issues and derive key source parameters through selection of items with high possibility of potential improvements in the clinical field based on Donabedian (1966) Paradigm as a conceptual framework, thereby developing and managing medication safety guidelines. Research was conducted, targeting doctors, nurses and pharmacists working at university hospital located in D city, and improvement team composed of nurses with more than 4 year working experiences in the applicable department and business improvement activities on the recommendation of the appropriate department head participated in the overall improvement activities with researchers. For data analysis, Minitab 16 PC+ program was used, and general characteristics of subjects were analyzed through the frequency and percentage. For survey analysis on the implementation of medication safety targeting nurses, doctors and pharmacists, Pareto chart analysis and content analysis were carried out, and to analyze the level of performance and knowledge on the pre and post-medication safety of application of high-risk intravenous medication safety guidelines targeting nurses, the standard deviation and Wilcoxon rank sum test were conducted. In addition to these, cause and effect diagram, 4 block matrix and logic tree analysis were utilized. This study was proceeded through 3 areas of structure, process and result of Donabedian (1966). In the structural area, organization's internal capabilities and external environment were analyzed, and in the process area, evaluation was made using 5-step process by DMAIC process of 6 sigma techniques. In the result area, checklists, educational interventions and medication safety guidelines standardized through the process area were deduced, and the results are as follows. First, as a result of analysis on the cause of problems in high-risk intravenous medication safety, frequent oral prescription, interruption of the medication process, negligence in checking patients, fluid infusion and fluid speed control and incorrect infusion were pointed out as process causes, and in case of environmental causes, there were inexperience in infusion device operation, packaging confusion, improper medication administration, absence of medication procedures manual, inadequate storage and confusion of injection capacity units. As nurse causes, lack of awareness and knowledge about drugs, hurry practices, shortage of nursing staffs and lack of drug education targeting nurses were marked. Taking high possibility of the actual promotion and performance into consideration, development and standardization of high-risk intravenous medication safety guidelines for nurses was selected as final the challenge to promote. Second, from the result of analysis on the level of high-risk intravenous mediation safety prior knowledge/performance of nurses, it turned out that identification of prescription and drug capacity, situations exposed when handling anticancer drugs, records on the anticancer medication and nursing and observations of cancer treatment were deduced as improvement items of knowledge, and in performance, checking prescription up with drug capacity, identification of the validity of drug, checking the patients, safe management and storage of high-risk critical care medicine were analyzed as major improvement items. As a result of analysis on the NaCl/ KCl and Heparin medication process, a wide variety of medication safety issues ranging from 'frequent oral prescription' in prescribed medication verification process of nurses resulting in problems in understanding of medication and process of performing medication, checking the patients, patient dose assessment, implementation process of medication and side effects of drugs to periodic monitoring process were raised. Third, total of 11 key source items according to 5 major issues on the high-risk intravenous medication safety of nurses were analyzed, and as a result of the research targeting improvement team, absence of major drug medication protocol by wards, lack of education on operations of medication infusion device, non-establishment of a standardized procedure to perform high-risk intravenous medication, lack of personalized medication education targeting nurses, lack of drug booklet kept in hospitals and negligence in checking packaging drugs in the similar containers were drawn as key factors. And among them, 4 key sources were selected as final causes and they were reflected in the improvement plans. Fourth, as contents of high-risk intravenous medication safety improvements, standardized high-risk intravenous medication safety process and checklists were drawn up based on the medication safety guidelines established by supplementing GAP deduced as medication safety problems identified in the medication process, and as a final step, an education plan to complement deficiencies identified in the procedures by stages was developed and it was provided as the final improvement plan for educational performance targeting nurses. Fifth, management plan including measures in the event of problems, persons in charge, management methods and management indicators applicable to medication safety checklist, medication performance process and high-risk intravenous medication safety guidelines was made out, and as a final step for completion of 6 sigma project, the final report including titles of the current proceedings, major problems, improvement issues, quantitative and qualitative effects corresponding to promotion results was drawn up. This study was designed to develop medication safety guidelines reflecting organization's needs to improve human errors through application of system approach starting from analyzing the applicable organizations and identifying the problems for the purpose of improvement of patient safety and satisfaction, thereby contributing to solving the fundamental problems in the medication implementation process and maintenance of the solved problems. In the mean time, this study has its significance in that it suggested strategies to improve human factors and establish safety system of medical institutions for improvement of medication safety through activities to improve and identify problems of the structural systems so that full compliance of the developed medication safety guidelines can be achieved within nursing procedures and regulations of the medical institutions.
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#투약안전 고위험 정맥주사 고위험 정맥주사 투약안전 지침 6시그마 기법
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