Research On The Construction Of Drug Risk Evaluation Index System In The Transfer Of Care

Part 1.Study on key factors influencing drug risk in the transfer of care process Aims: This part analyzes the influencing factors of drug safety risks in the process of transfer of care,and tries to establish medication risk management plan,in order to provide theoretical basis for improving clinical drug safety.Methods: Based on a structural equation model,a questionnaire survey was conducted to explore the key influencing factors of drug safety in the process of transfer of care.We used the classical “structure-process-outcome” three-dimensional theoretical framework of health system performance evaluation as the main conceptual model.By referring to domestic and international studies on transfer of care,quality evaluation of transfer or referral,drug risk management and other aspects,a questionnaire was developed for clinicians,clinical pharmacists and nurses in five comprehensive hospitals in Anhui Province.Results: Two hundred ninety-two medical staff members participated in the questionnaire survey.Structural factors(environment,resources,regulations and policies)in the transfer of care process positively influence the process of care(care activities and specific measures),and process factors positively influence outcome factors(patient outcomes and quality of care),while the direct effect of structural factors on the outcome factors is temporarily not reflected.Conclusion: Structural factors such as the environment,resources,and system construction can have an impact on the process or specific measures of care and then affect patient outcomes and care quality.Medical institutions should improve the quality of transfer of care from the structural dimension,such as optimizing relevant systems and perfecting databases.For the process dimension,patients should be the focus,and clinical diagnosis and medication records should be carefully recorded to ensure the accurate transmission of information.Part 2.Construction of drug risk evaluation index system in the transfer of care processAims: On the basis of identifying the factors affecting drug safety risk in the first part of the project,the drug risk evaluation index system in the transfer of care process is constructed,and drug safety risk in this process is comprehensively evaluated from the three dimensions of structure,process and outcome,so as to promote the continuous improvement of the quality of transfer care and provide useful reference for drug risk assessment and comprehensive management in this period and quarantee medication safety of patients.Methods: According to the items in the questionnaire of influencing factors in the first part of the project and the results of literature analysis in this part,the primary,secondary and tertiary indicators are preliminarily extracted.Combined with Delphi expert correspondence method and analytic hierarchy process,the indicators are repeatedly screened and modified,and the weights and combined weights of indicators at all levels are calculated to analyze the importance of indicators at different levels in the whole index system.Results: Two rounds of expert consultation were completed,the questionnaire recovery rate was 100%,the expert authority coefficient was 0.835 and 0.828,respectively,and the opinions on each index were consistent.Finally,the index system framework of drug risk evaluation during the transfer care process was determined,which included 3primary indicators,6 secondary indicators and 32 tertiary indicators.The analytic hierarchy process is used to calculate the weights of indicators at all levels.The consistency ratio CR of indicators at all levels is less than 0.1,indicating that there is no logical error among indicators at all levels and the weight distribution is consistent.Conclusion: Based on Donabedian’s "structure-process-outcome" three-dimensional quality evaluation model,a drug risk evaluation index system in the transfer of care process was established in this study,including 3 first-level indicators,6 second-level indicators and 32 third-level indicators.The index construction method is real,scientific and reliable,and indicators at all levels can reflect the situation of each dimension,which can provide reference for reducing drug safety risks and improving the quality of transfer of care.