Transcript 2 s & 7 EP

‫استانداردهاي ‪ JCAHO‬در تجويز و مصرف‬
‫دارو در بيمارستان‬
‫دكتر شهرام توفيقي ‪MD.PhD‬‬
‫همايش خطاهاي پزشكي‬
‫خرم آباد ارديبهشت ‪1384‬‬
JCAHO
Joint Comission on Accredtion
of Health Organizations
‫كميسيون مشترك اعتباربخش ي به سازمان هاي‬
‫بهداشتي ودرماني‬
‫انستيتوي پزشكي )‪ Institute of Medicine (IOM‬در سال‬
‫‪ 2000‬گزارش ي منتشركرد به نام‪:‬‬
‫‪To Err Is Human: Building Safe Health‬‬
‫در اين گزارش وضعيت تجويز و مصرف دارو در بيمارستان هاي امريكا‬
‫مورد بررس ي و تحليل قرار گرفت‪.‬‬
‫بر اساس اين گزارش ساالنه حدود ‪ 100000‬نفر از تجويز نابجاي دارو‬
‫آسيب ديده و حدود ‪ 17000‬نفرمي ميرند‪.‬‬
Process of medication
• Prescribing
%39 events
wrong dose/wrong choice/known allergy
• Transcribing
%12 events
wrong dose/wrong frequency/missed dose
• Dispensing
%11 events
wrong dose/wrong drug/wrong time
• Administering %38 events
wrong dose/wrong choice/wrong drug
Intervention with CPOE
Computerized Physician Order Entry
• Prescribing
%39 events
%48 prev.
• Transcribing
%12 events
%33 prev
• Dispensing
%11 events
%34 prev.
• Administering %38 events
%2 prev.
Medication Management
selction & procurement
storage
oredering & transcribing
‫ انتخاب و تامين‬.1
‫ انبارش‬.2
‫ دستور دهي و ترا نويس ي‬.3
preparation & dispensing‫ آماده سازي و نسخه پيچي‬.4
administration
‫ مصرف‬.5
clinical monitiring of effects ‫ پايش باليني اثرات‬.6
‫مقدمه‬
‫آنچه درمتن راهنماي استاندارد آمده‪:‬‬
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‫•‬
‫•‬
‫•‬
‫گزاره استاندارد‬
‫عناصرعملكردي ‪Elements of Performance‬‬
‫امتيازدهي به هر ‪EP‬‬
‫فعاليت هايي كه براي بررس ي ميزان انطباق وضعيت با استانداردها‬
‫انجام مي شود‪.‬‬
‫استانداردها در ‪ 9‬دسته و‪ 24‬گزاره استاندارد و ‪ 127‬عنصر عملكردي ارائه‬
‫شده اند‪.‬‬
Medication Management Standards
1.
2.
3.
4.
5.
6.
7.
8.
9.
Patient’s Information (1 s & 3 EP)
Selection & Procurement (1 s & 7 EP)
Storage (3 s & 24 EP)
Ordering & Transcribing (2 s & 13 EP)
Preparing & Dispensing (8 s & 34 EP)
Adminstering (2 s & 25 EP)
Monitoring (2 s & 7 EP)
High-risk Medication (4 s & 8 EP)
Evaluation (1 s & 6 EP)
Medication Management Standards
1. Patient’s Information (1 s & 3 EP)
2.
3.
4.
5.
6.
7.
8.
9.
Selection & Procurement (1 s & 7 EP)
Storage (3 s & 24 EP)
Ordering & Transcribing (2 s & 13 EP)
Preparing & Dispensing (8 s & 34 EP)
Adminstering (2 s & 25 EP)
Monitoring (2 s & 7 EP)
High-risk Medication (4 s & 8 EP)
Evaluation (1 s & 6 EP)
1.Patient’s Information(1)
Standard MM.1.10 –
Patient-specific information is
readily acessible to those
involved in the medication
management system.
1.Patient’s Information(2)
Medication safety is
compromised whenever
there is a lack of
information.
1.Patient’s Information(3)
EP1:
A written policy describing the
minimum information that must
be available to those involved
in medication management is
required.
1.Patient’s Information(4)
EP2:
List
of
the
information
minimum
that
required
should
be
incorporated into the policy, when
applicable to the services noted.
1.Patient’s Information(5)
EP3:
This EP states that the required
information is accessible when
needed, except in emergency
situations in which time does
not permit
Medication Management Standards
1.
Patient’s Information (1 s & 3 EP)
2. Selection & Procurement (1 s & 7 EP)
3.
4.
5.
6.
7.
8.
9.
Storage (3 s & 24 EP)
Ordering & Transcribing (2 s & 13 EP)
Preparing & Dispensing (8 s & 34 EP)
Adminstering (2 s & 25 EP)
Monitoring (2 s & 7 EP)
High-risk Medication (4 s & 8 EP)
Evaluation (1 s & 6 EP)
2.Selection & Procurement(1)
Standard MM.2.10Medications
available
for
dispensing are selected,
listed, and procured based
on criteria.
2.Selection & Procurement(2)
EP1:
There are a committee including
medical staff for developing
criteria for drugs that are added or
deleted from formulary list. The
criteria should be written for
hospital.
2.Selection & Procurement(3)
EP2:
The criteria for drugs on the list
required to include the indication
for use, effectiveness, risks, and
cost.
2.Selection & Procurement(4)
EP3:
Formulary must indicate the
strenght and dosage form. The
list should be easily available
when requested.
2.Selection & Procurement(5)
EP4:
Requires the organization to
have ability to monitor a drug
prior to addition to formulary.
2.Selection & Procurement(6)
EP5:
The approved formulary should be
reviewed at least once a year,
and more frequently in response
to any emerging safety and
efficecy data.
2.Selection & Procurement(7)
EP6:
Each organization should maintain
a
process
for
approving
and
procuring medications that are not
on the formulary.
2.Selection & Procurement(8)
EP7:
Organization should have an stablished
process for handling drug shortages.
Communicating with prescribers and
staff,
developing
approved
substitution protocoles, educating
appropriate physicians and staff about
these protocols.
Medication Management Standards
1.
2.
Patient’s Information (1 s & 3 EP)
Selection & Procurement (1 s & 7 EP)
3. Storage (3 s & 24 EP)
4.
5.
6.
7.
8.
9.
Ordering & Transcribing (2 s & 13 EP)
Preparing & Dispensing (8 s & 34 EP)
Adminstering (2 s & 25 EP)
Monitoring (2 s & 7 EP)
High-risk Medication (4 s & 8 EP)
Evaluation (1 s & 6 EP)
3.Storage(1)
Standard MM.2.20Medications are properly and
safely stored throughout the
hospital.
3.Storage(2)
Standard MM.2.30Emergency menications and/or
supplies, if any, are consistently
available,
controlled,
and
secure in the organization’s
patient care areas.
3.Storage(3)
Standard MM.2.40-
A process is established to
safely manage medications
brought into the organization
by patients or their families.
Medication Management Standards
1.
2.
3.
Patient’s Information (1 s & 3 EP)
Selection & Procurement (1 s & 7 EP)
Storage (3 s & 24 EP)
4. Ordering & Transcribing (2 s & 13 EP)
5.
6.
7.
8.
9.
Preparing & Dispensing (8 s & 34 EP)
Adminstering (2 s & 25 EP)
Monitoring (2 s & 7 EP)
High-risk Medication (4 s & 8 EP)
Evaluation (1 s & 6 EP)
4.Ordering & Transcribing(1)
Standard MM.3.10Only medications needed to
treat the patient’s condition
are ordered.
4.Ordering & Transcribing(2)
Standard MM.3.20Medication orders are written
clearly
and
accurately.
transcribed
Medication Management Standards
1.
2.
3.
4.
Patient’s Information (1 s & 3 EP)
Selection & Procurement (1 s & 7 EP)
Storage (3 s & 24 EP)
Ordering & Transcribing (2 s & 13 EP)
5. Preparing & Dispensing (8 s & 34 EP)
6.
7.
8.
9.
Adminstering (2 s & 25 EP)
Monitoring (2 s & 7 EP)
High-risk Medication (4 s & 8 EP)
Evaluation (1 s & 6 EP)
5.Preparing & Dispensing(1)
Standard MM.4.10-
All prescriptions or medication
orders
are
reviewed
appropriateness.
for
5.Preparing & Dispensing(2)
Standard MM.4.20Medications are prepared
safely.
5.Preparing & Dispensing(3)
Standard MM.4.30Medications are appropriately
labeled.
5.Preparing & Dispensing(4)
Standard MM.4.40Medications are dispensed
safely.
5.Preparing & Dispensing(5)
Standard MM.4.50The hospital has a system for
safely providing medications to
meet patient needs when the
pharmacy is closed.
5.Preparing & Dispensing(6)
Standard MM.4-60:
If the organization does not operate a
pharmacy but routinely administers
medications, the organization has a
process for obtaining medications
from a pharmacy.
5.Preparing & Dispensing(7)
Standard MM.4.70Medications dipensed by the
hospital are retrieved when
recalled or discontinued by the
manufacturer or the FDA for
the safety reasons.
5.Preparing & Dispensing(8)
Standard MM.4.80Medications
pharmacy
managed.
returned
are
to
the
appropriately
Medication Management Standards
1.
2.
3.
4.
5.
Patient’s Information (1 s & 3 EP)
Selection & Procurement (1 s & 7 EP)
Storage (3 s & 24 EP)
Ordering & Transcribing (2 s & 13 EP)
Preparing & Dispensing (8 s & 34 EP)
6. Adminstering (2 s & 25 EP)
7.
8.
9.
Monitoring (2 s & 7 EP)
High-risk Medication (4 s & 8 EP)
Evaluation (1 s & 6 EP)
6.Administering(1)
Standard MM.5.10Medications
are
safely
accurately administered.
and
6.Administering(2)
Standard MM.5.20Self-administered
are
safely
administered.
and
medications
accurately
Medication Management Standards
1.
2.
3.
4.
5.
6.
Patient’s Information (1 s & 3 EP)
Selection & Procurement (1 s & 7 EP)
Storage (3 s & 24 EP)
Ordering & Transcribing (2 s & 13 EP)
Preparing & Dispensing (8 s & 34 EP)
Adminstering (2 s & 25 EP)
7. Monitoring (2 s & 7 EP)
8.
9.
High-risk Medication (4 s & 8 EP)
Evaluation (1 s & 6 EP)
7.Monitoring(1)
Standard MM.6.10The effects of medication(s) on
patients are monitored.
7.Monitoring(2)
Standard MM.6.20The hospital responds appropriately
to actual or potential adverse drug
events and medication errors.
Medication Management Standards
1.
2.
3.
4.
5.
6.
7.
Patient’s Information (1 s & 3 EP)
Selection & Procurement (1 s & 7 EP)
Storage (3 s & 24 EP)
Ordering & Transcribing (2 s & 13 EP)
Preparing & Dispensing (8 s & 34 EP)
Adminstering (2 s & 25 EP)
Monitoring (2 s & 7 EP)
8. High-risk Medication (4 s & 8 EP)
9.
Evaluation (1 s & 6 EP)
8.High-Risk Medications(1)
Standard MM.7.10The hospital develops processes
for managing high-risk or high-
alert medications.
8.High-Risk Medications(2)
Standard MM.7.20Psychtropic medication use is
monitored.
8.High-Risk Medications(3)
Standard MM.7.30The use of psychopharmacologic
drugs is monitored.
8.High-Risk Medications(4)
Standard MM.7.40Investigational
medications
are safely controlled and
administered.
Medication Management Standards
1.
2.
3.
4.
5.
6.
7.
8.
Patient’s Information (1 s & 3 EP)
Selection & Procurement (1 s & 7 EP)
Storage (3 s & 24 EP)
Ordering & Transcribing (2 s & 13 EP)
Preparing & Dispensing (8 s & 34 EP)
Adminstering (2 s & 25 EP)
Monitoring (2 s & 7 EP)
High-risk Medication (4 s & 8 EP)
9. Evaluation (1 s & 6 EP)
9.Evaluation(1)
Standard MM.8.10The hospital evaluates its
medication
system.
management
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