Imbedding Research in Practice to Improve Medication Safety
نویسندگان
چکیده
Objective: The objective of this project was to improve medication safety at Kaiser Permanente Colorado (KPCO). Methods: Six projects that included over 400,000 members were conducted at medical offices and pharmacies. They focused on drug-drug interactions, warfarin-drug interactions, dosing in patients with impaired kidney function, prescribing among elderly patients, prescribing during pregnancy, and laboratory monitoring of therapy. Physicians and pharmacists collaborated to determine study medications, develop intervention guidelines, and implement interventions. Pharmacists were alerted to potential errors through a computerized tool that prevented prescription dispensing until after intervention. Multiple techniques were used in change management. Results: All interventions reduced errors (range, 13 to 45 percent), with more than 4,000 errors avoided during the research phases. Five interventions were maintained/modified into routine care at KPCO; some were implemented elsewhere. Conclusion: This program supports goals common to many health systems. It was developed through communication, staff support, and stakeholder involvement and successfully decreased medication errors through interventions implemented at medication dispensing.
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