Quality Indicators for Safe Medication Preparation and Administration: A Systematic Review

BackgroundOne-third of all medication errors causing harm to hospitalized patients occur in the medication preparation and administration phase, which is predominantly a nursing activity. To monitor, evaluate and improve the quality and safety of this process, evidence-based quality indicators can be used.ObjectivesThe aim of study was to identify evidence-based quality indicators (structure, process and outcome) for safe in-hospital medication preparation and administration.MethodsMEDLINE, EMBASE and CINAHL were searched for relevant studies published up to January 2015. Additionally, nine databases were searched to identify relevant grey literature. Two reviewers independently selected studies if (1) the method for quality indicator development combined a literature search with expert panel opinion, (2) the study contained quality indicators on medication safety, and (3) any of the quality indicators were applicable to hospital medication preparation and administration. A multidisciplinary team appraised the studies independently using the AIRE instrument, which contains four domains and 20 items. Quality indicators applicable to in-hospital medication preparation and administration were extracted using a structured form.ResultsThe search identified 1683 studies, of which 64 were reviewed in detail and five met the inclusion criteria. Overall, according to the AIRE domains, all studies were clear on purpose; most of them applied stakeholder involvement and used evidence reasonably; usage of the indicator in practice was scarcely described. A total of 21 quality indicators were identified: 5 structure indicators (e.g. safety management and high alert medication), 11 process indicators (e.g. verification and protocols) and 5 outcome indicators (e.g. harm and death). These quality indicators partially cover the 7 rights.ConclusionDespite the relatively small number of included studies, the identified quality indicators can serve as an excellent starting point for further development of nursing specific quality indicators for medication safety. Especially on the right patient, right route, right time and right documentation there is room future development of quality indicators.### 背景 在导致住院患者遭受损害的所有用药差错中，有三分之一发生在药物配制与给药阶段，而该环节的工作主要由护理人员承担。为监测、评估并优化这一流程的质量与安全性，可采用基于证据的质量指标。 ### 研究目标 本研究旨在识别适用于院内安全药物配制与给药的基于证据的质量指标，涵盖结构类、流程类与结果类三类指标。 ### 研究方法 检索截至2015年1月发表的相关研究，数据库包括MEDLINE、EMBASE及CINAHL；此外还检索了9个数据库以获取相关灰色文献。由两名研究者独立筛选符合以下全部三项标准的研究：(1) 质量指标开发方法结合了文献检索与专家小组论证；(2) 研究包含用药安全相关质量指标；(3) 存在适用于院内药物配制与给药环节的质量指标。由多学科团队采用包含4个维度、20个条目的AIRE评价工具独立对纳入研究进行质量评价，并采用结构化表格提取适用于院内药物配制与给药的质量指标。 ### 研究结果 本次检索共获得1683项研究，其中64项经详细审阅，最终5项符合纳入标准。总体而言，依据AIRE评价工具的维度分析，所有研究均明确阐述了研究目的；多数研究纳入了利益相关方参与环节，并合理运用了研究证据，但极少有研究描述了质量指标在临床实践中的实际应用情况。本研究共识别出21项质量指标：其中结构类指标5项（如安全管理、高警示药物管理）、流程类指标11项（如核对流程、操作规范）以及结果类指标5项（如患者损害事件、死亡事件）。上述质量指标仅部分覆盖了“七项给药正确准则”。 ### 结论 尽管纳入的研究数量相对较少，但本研究识别出的质量指标可作为进一步开发护理专属用药安全质量指标的良好起点。尤其是在正确识别患者、正确给药途径、正确给药时间以及正确记录这几个环节，仍存在开发相关质量指标的充足空间。