Research Of Risk-control Mechanism Of High-alert Medications In Hospitals In China

[Purpose] Objective Identify and evaluate the risk factors and core responsibility subjects of high-alert medications in internal circulation of hospitals by establishing candidate groups for risk control elements of high-alert medications and risk control responsibility subjects;investigate the mechanism of effects of the key elements on the risk circulation of high-alert medications in hospitals;discuss the division of responsibility and risk as well as appeal of high-alert medications risk control subjects.Based on the risk control mechanism of key control factors,proposes risk control strategies for high-alert medications in hospitals to strengthen the safety of patients' medication.[Methods] Research status and hotspots in the field of high-alert medications management were analyzed through literature research and bibliometric analysis.Quantitative and qualitative data of the risk of high-alert medications were obtained by on-site investigation,expert consultation and risk monitoring of sample hospitals.Mathematical statistics methods were employed to investigate elements affecting the cognitive level of high-alert medications for medical staff,the risk level of risk factors and the subjects of risk control and their appeals,following by establishing the risk control mechanism for high-alert medications and proposing targeted risk control strategies.[Results](1)Bibliometric analysis of high-alert medications management at home and abroad showed that research in this field mainly focused on the safety of medication for the elderly,the management practice such as high-alert medications management methods and effect evaluation in medical institutions,as well as medical staff's cognition of high-alert medications.(2)Results of on-site questionnaire showed that the highest score of the highest awareness of high-alert medications among medical staff were pharmacists(9.26),among which the clinical pharmacy staff scored the highest(9.56),and clinicians got the second highest score(8.20),followed by the nursing staff(7.94);the two main factors affecting the cognitive level of high-alert medications for medical staff were the difference of departments and whether to obtain knowledge of high-alert medications from the network.Compared with internal medicine,pharmacy(P<0.05,OR= 3.873)and clinical pharmacy(P<0.05,OR=3.289)had a higher level of high-risk cognition;the cognitive level of medical staff who obtained high-alert medications knowledge through network access(P<0.05,OR=0.275)was lower than that obtained by non-network access.(3)The risk key links of high-alert medications in the hospital circulation process are: prescription,drug use,drug review,drug dispensing.The key elements of risk control are: nurses did not carry out necessary monitoring on patients using high-alert medications;nurses made mistakes while checking patients' information;mistakes in dispensing high-alert medications in outpatient pharmacy;doctors and/or pharmacists did not explain the proper way of administration to patients;nursing staff used wrong methods due to the lack of knowledge and experience.(4)The subjects of core responsibility of high-alert medications risk control are: doctors,nurses,pharmacists,hospital administrators,and quality control departments.87.86% of the medical staff claimed that the hospital management should arrange regular high-alert medications knowledge training to make up for the lack of their professional knowledge,and hope to play the role as pharmacists to guide the safe use of high-alert medications.(5)The estimated target risk probability of hospital high-alert medications is 0.0187 and the combination of the two risk factors(nurses did not carry out necessary monitoring on patients using high-alert medications and doctors and pharmacists did not explain the medication methods to patients)would minimize the probability of the final result of the risk of high-alert medications in hospitals to 0.0038.[Conclusion](1)It is benefits to help us to quickly control potential risk factors in daily risk management that defining the concept of high-alert medications risk and grasping the possible links of risk factors for high-alert medications in hospitals.(2)Error-prone links have different connotations and different links with the most harmful links caused by errors.Critical error links of high-alert medications do more harm to patients.More attention should be paid to the standardized management of the key risk factors of critical error links and the main body responsible for risk control.(3)Nurses are responsible for the key risk control links of high-alert medications,but their professional skills are low.Pharmacists play many roles in high-alert medications risk links and have a high professional level.Therefore,pharmacists play an important role in medical institutions,and strengthen training and medication guidance for other medical personnel,especially nurses.(4)It will be achieved of the effect of better reducing the risk of high-alert medications in hospital through the establishment of high-alert medications risk disposal emergency plan and other standardized and effective high-alert medications risk control strategies.