目的:审核对于审查和改进药物使用过程至关重要。确定需要改进的领域可以限制制备和施用药物时出错的风险。儿科中心在确保药物使用过程的安全性方面面临着特殊的挑战。这项研究的目的是连续两年观察和比较母婴大学医院中心护士对药物准备和给药标准的依从性。
方法:这项观察性横断面研究是在加拿大母婴大学医院中心进行的。分别于2021年和2022年对16个和18个护理行业进行了为期1个月的审计。标准化审核评估了与护理人员准备和管理药物相关的预先指定标准的遵守情况(2021年为77条标准,2022年为82条标准)。审计人员包括护士和一名由研究小组培训的药剂师。比较年份之间的依从性,并通过卡方检验进行评估。
结果:审计包括2021年的522个观察结果和2022年的448个观察结果。整体合规率在2021年为76%,2022年为66%。按标准划分的依从16%到100%不等。2021年和2022年,51(84%)和52(87%)的标准,分别,达标率超过75%,12(20%)和8(13%),分别,100%合规。在39项药物准备标准中,有9项的依从性在统计学上显着下降,特别是先前的手部卫生(91%与84%,p=0.002),对于17项药物管理标准中的6项,包括提及对患者可能产生的不良影响(41%vs-30%,p=0.008)。
结论:在这项研究中,大多数标准的依从性超过75%。然而,对于一些标准,我们观察到,从2021年到2022年,合规性有所下降。提出了各种假设来解释这些减少,例如COVID-19大流行。
OBJECTIVE: Audits are essential for reviewing and improving the medication-use process. Identifying areas for improvement can limit the risk of errors when preparing and administering drugs. Pediatric centers face specific challenges in ensuring the safety of the medication-use process. The objective of this study was to observe and compare compliance with criteria for the preparation and administration of medications by nurses in a mother-and-child university hospital center over two consecutive years.
METHODS: This observational cross-sectional study was conducted in a Canadian mother-and-child university hospital center. Audits were conducted over a 1-month period in 16 and 18 nursing care sectors in 2021 and 2022, respectively. The standardized audit evaluated compliance with prespecified criteria related to the preparation and administration of medication by nursing staff (77 criteria for 2021 and 82 criteria for 2022). The auditors comprised nurses and a pharmacist trained by the research team. Compliance was compared between years and assessed through a chi-square test.
RESULTS: The audit consisted of 522 observations in 2021 and 448 observations in 2022. Overall compliance was 76% in 2021 and 66% in 2022. The compliance rate by criterion ranged from 16% to 100%. In 2021 and 2022, 51 (84%) and 52 (87%) of the criteria, respectively, had compliance rates of more than 75%, and 12 (20%) and eight (13%), respectively, had 100% compliance. There were statistically significant decreases in compliance for nine of the 39 criteria for preparation of medications, notably prior hand hygiene (91%% vs. 84%, p = 0.002), and for six of the 17 criteria for administration of medications, including mentioning possible adverse effects to the patient (41% vs- 30%, p = 0.008).
CONCLUSIONS: In this study, compliance was over 75% for most of the criteria. However, for a few criteria, we observed a decrease in compliance from 2021 to 2022. Various hypotheses are proposed to explain these decreases, such as the COVID-19 pandemic.