背景:重症监护病房(ICU)的患者由于许多原因容易出现用药错误(ME),包括护理的复杂性和强度。对患者安全文化知之甚少,它与药物安全的关系,和重症监护室中使用的ME预防策略。这项研究探讨了在ICU或在药物安全范围内工作的医疗保健专业人员(HCP)对患者安全文化的态度,用药安全,以及影响欧洲ICU实施ME预防策略的因素。
方法:这项定性研究采用焦点小组讨论;获得了伦理认可。参加邀请已分发给在ICU工作的HCP或在欧洲担任药物安全官员。2022年5月,进行了在线焦点小组讨论。讨论被逐字转录和分析。采用的框架分析是归纳的,系统和透明,并经由过程协作和迭代完成。
结果:3名护士和11名药剂师,来自七个不同的国家,参加了三次焦点小组讨论。责备文化有一种进步感,导致更开放的文化,尽管并非所有参与者都如此。责备文化,当存在时,被认为在更高级的ICU工作人员和医院管理人员中普遍存在。改善用药安全的促进者包括与HCP沟通,并提供有关ME和ME预防策略的反馈。没有等级制度的跨专业工作,拥有良好的文化和环境。障碍包括缺乏HCPs的参与和他们对药物安全的态度,和现有的责备文化。参与者报告了使用的25种不同的ME预防策略,包括:评估知识;教学和培训;审核实践;事件报告;和药剂师的参与。
结论:本研究调查了欧洲ICU环境中HCPs对患者安全文化和用药安全的态度,并了解了实施ME预防策略以提高用药安全性的促进者和障碍。
BACKGROUND: Patients in intensive care units (ICUs) are susceptible to medication errors (MEs) for many reasons, including the complexity and intensity of care. Little is known about patient safety culture, its relationship to medication safety, and ME prevention strategies used in ICUs. This study explored the attitudes of healthcare professionals (HCPs) working in ICUs or within medication safety towards patient safety culture, medication safety, and factors influencing implementation of ME prevention strategies in ICUs across Europe.
METHODS: This qualitative study employed focus group discussions; ethical approval was obtained. Invitations to participate were distributed to HCPs working in ICUs or as medication safety officers across Europe. In May 2022, online focus group discussions were conducted. Discussions were transcribed verbatim and analysed. The framework analysis employed was inductive, systematic and transparent, and completed through a collaborative and iterative process.
RESULTS: Three nurses and 11 pharmacists, from seven different countries, participated in three focus group discussions. There was a sense of improvement in blame culture leading to more open culture, although it was not the case for all participants. Blame culture, when present, was thought to be prevalent among more senior ICU staff and hospital managers. Facilitators for improving medication safety included communicating with HCPs and providing feedback on MEs and ME prevention strategies, interprofessional working without hierarchies, and having a \'good\' culture and environment. Barriers included lack of engagement of HCPs and their attitudes towards medication safety, and an existing blame culture. Participants reported 25 different ME prevention strategies in use including: assessing knowledge; teaching and training; auditing practice; incident reporting; and involvement of pharmacists.
CONCLUSIONS: This study examined the attitudes of HCPs on patient safety culture and medication safety in the ICU setting in Europe and gained their insight into facilitators and barriers to the implementation of ME prevention strategies to improve medication safety.