背景:一些指南支持个体患者的多重用药管理。需要更多的组织层面关注实施框架的使用。
目的:为了描述关于实现框架的同行评审文献,在多药房管理的背景下,重点关注组织层面实施的障碍和促进者。
方法:设计了范围审查方案,支持检索英文发表的研究,任何实践部门的报告。Medline,国际医药文摘,到2022年1月,使用医学主题词搜索了护理和相关健康文献和商业来源的累积指数,包括:“多药房”,\'处方无效\',“战略规划”和“组织创新”。采用了叙事方法进行数据综合。正在搜索,数据提取和综合由两名评审员独立进行。
结果:筛选后797条记录还剩下8篇论文。两个是描述性概述具体举措的细节,六个使用定性方法来探索实施的决定因素,包括障碍和促成因素。组织层面的障碍包括:不良的组织文化,缺乏紧迫感和国家计划,资源可用性和沟通问题,包括患者信息和护理过渡。组织促进者包括政府资金的可用性和促进患者安全的监管环境,国家强调老年人的护理质量,协调国家努力和地方证据。
结论:有限的文献侧重于在组织层面使用实施框架。这项审查强调了在这种情况下需要进一步开展实施框架工作,以帮助实现有效的组织变革。
BACKGROUND: Several guidelines support polypharmacy management in individual patients. More organisational-level focus is needed on the use of implementation frameworks.
OBJECTIVE: To characterise the peer reviewed literature on implementation frameworks, focussing on barriers and facilitators to implementation at organisational level in the context of polypharmacy management.
METHODS: A scoping review protocol was devised, supporting retrieval of studies published in English, reporting from any sector of practice. Medline, International Pharmaceutical Abstracts, Cumulative Index of Nursing and Allied Health Literature and Business Source Complete were searched to January 2022 using Medical Subject Headings including: \'polypharmacy\', \'deprescriptions\', \'strategic planning\' and \'organizational innovation\'. A narrative approach to data synthesis was applied. Searching, data extraction and synthesis were undertaken independently by two reviewers.
RESULTS: After screening 797 records eight papers remained. Two were descriptive outlining details of specific initiatives, six used qualitative methods to explore determinants for implementation including barriers and enablers. Organisation level barriers included: poor organisational culture with a lack of sense of urgency and national plans, resource availability and communication issues including patient information and at transitions of care. Organisational facilitators included availability of government funding and regulatory environment promoting patient safety, a national emphasis on quality of care for older adults, co-ordinated national efforts and local evidence.
CONCLUSIONS: Limited literature focusses on the use of implementation frameworks at organisational levels. This review highlights the need for further work on implementation frameworks in this context to help achieve effective organisational change.