استانداردهاي jcaho در تجويز و مصرف دارو در بيمارستان دكتر...

در تجويز و JCAHOاستانداردهاي مصرف دارو در بيمارستان

توفيقي شهرام MD.PhDدكترپزشكي خطاهاي همايش

ارديبهشت آباد 1384خرم

JCAHO

Joint Comission on Accredtion of Health Organizations

كميسيون مشترك اعتبار بخشي به سازمان هاي

بهداشتي ودرماني

پزش!كي Institute of Medicine (IOM)انس!تيتوي گزارشي منتش!ر كرد !به نام:2000در سال

To Err Is Human: Building Safe Health

در اين گ!زارش وض!عيت تج!ويز و مص!رف دارو در بيمارس!تان ه!اي !امريك!ا م!ورد ب!ررس!ي و تحلي!ل

قرار گرفت.

ح!دود گ!زارش س!االنه اين اس!اس 100000بر نف!ر از تج!ويز ناب!ج!اي دارو! آس!يب دي!ده و ح!دود

ن!فر مي !ميرند.17000

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 CPOEComputerized 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 & procurementانتخاب و تامين 1.

storageانبارش 2.

&transcribing orederingدستور دهي و ترا نويسي3.

preparation & dispensingآماده سازي و نسخه پيچي4.

مصرف 5.

administration

clinical monitiring of effectsپايش باليني اثرات 6.

مقدمه

آنچه در متن راهنماي استاندارد آمده:

گزاره استاندارد •Performance Elements ofعناصر عملكردي •EPامتيازدهي به هر •م!يزان • بررس!ي ب!راي ك!ه ه!ايي فع!اليت

انج!ام مي اس!تانداردها ب!ا انطب!اق وض!عيت شود.

گ!زاره اس!تاندارد 24 دس!ته و9اس!تانداردها در عنصر عملكردي !ارائه !شده اند.!127و !

Medication Management Standards

1. Patient’s Information (1 s & 3 EP)

2. Selection & Procurement (1 s & 7 EP)

3. Storage (3 s & 24 EP)

4. Ordering & Transcribing (2 s & 13 EP)

5. Preparing & Dispensing (8 s & 34 EP)

6. Adminstering (2 s & 25 EP)

7. Monitoring (2 s & 7 EP)

8. High-risk Medication (4 s & 8 EP)

9. Evaluation (1 s & 6 EP)

Medication Management Standards

1. Patient’s Information (1 s & 3 EP)2. Selection & Procurement (1 s & 7 EP)

3. Storage (3 s & 24 EP)

4. Ordering & Transcribing (2 s & 13 EP)

5. Preparing & Dispensing (8 s & 34 EP)

6. Adminstering (2 s & 25 EP)

7. Monitoring (2 s & 7 EP)

8. High-risk Medication (4 s & 8 EP)

9. 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 minimum required

information that 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. Storage (3 s & 24 EP)

4. Ordering & Transcribing (2 s & 13 EP)

5. Preparing & Dispensing (8 s & 34 EP)

6. Adminstering (2 s & 25 EP)

7. Monitoring (2 s & 7 EP)

8. High-risk Medication (4 s & 8 EP)

9. Evaluation (1 s & 6 EP)

2.Selection & Procurement(1)

Standard MM.2.10-Medications 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. Patient’s Information (1 s & 3 EP)

2. Selection & Procurement (1 s & 7 EP)

3. Storage (3 s & 24 EP)4. Ordering & Transcribing (2 s & 13 EP)

5. Preparing & Dispensing (8 s & 34 EP)

6. Adminstering (2 s & 25 EP)

7. Monitoring (2 s & 7 EP)

8. High-risk Medication (4 s & 8 EP)

9. Evaluation (1 s & 6 EP)

3.Storage(1)

Standard MM.2.20-

Medications are properly and

safely stored throughout the

hospital.

3.Storage(2)

Standard MM.2.30-

Emergency 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. Patient’s Information (1 s & 3 EP)

2. Selection & Procurement (1 s & 7 EP)

3. Storage (3 s & 24 EP)

4. Ordering & Transcribing (2 s & 13 EP)5. Preparing & Dispensing (8 s & 34 EP)

6. Adminstering (2 s & 25 EP)

7. Monitoring (2 s & 7 EP)

8. High-risk Medication (4 s & 8 EP)

9. Evaluation (1 s & 6 EP)

4.Ordering & Transcribing(1)

Standard MM.3.10-

Only medications needed to treat the patient’s condition are ordered.

Standard MM.3.20-

Medication orders are written

clearly and transcribed

accurately.

4.Ordering & Transcribing(2)

Medication Management Standards

1. Patient’s Information (1 s & 3 EP)

2. Selection & Procurement (1 s & 7 EP)

3. Storage (3 s & 24 EP)

4. Ordering & Transcribing (2 s & 13 EP)

5. Preparing & Dispensing (8 s & 34 EP)6. Adminstering (2 s & 25 EP)

7. Monitoring (2 s & 7 EP)

8. High-risk Medication (4 s & 8 EP)

9. Evaluation (1 s & 6 EP)

5.Preparing & Dispensing(1)

Standard MM.4.10-

All prescriptions or medication

orders are reviewed for

appropriateness.

5.Preparing & Dispensing(2)

Standard MM.4.20-

Medications are prepared

safely.

5.Preparing & Dispensing(3)

Standard MM.4.30-

Medications are appropriately

labeled.

5.Preparing & Dispensing(4)

Standard MM.4.40-

Medications are dispensed

safely.

5.Preparing & Dispensing(5)

Standard MM.4.50-

The 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.4.70-Medications 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.4.80-

Medications returned to the

pharmacy are appropriately

managed.

Medication Management Standards

1. Patient’s Information (1 s & 3 EP)

2. Selection & Procurement (1 s & 7 EP)

3. Storage (3 s & 24 EP)

4. Ordering & Transcribing (2 s & 13 EP)

5. Preparing & Dispensing (8 s & 34 EP)

6. Adminstering (2 s & 25 EP)7. Monitoring (2 s & 7 EP)

8. High-risk Medication (4 s & 8 EP)

9. Evaluation (1 s & 6 EP)

6.Administering(1)

Standard MM.5.10-

Medications are safely and

accurately administered.

6.Administering(2)

Standard MM.5.20-

Self-administered medications

are safely and accurately

administered.

Medication Management Standards

1. Patient’s Information (1 s & 3 EP)

2. Selection & Procurement (1 s & 7 EP)

3. Storage (3 s & 24 EP)

4. Ordering & Transcribing (2 s & 13 EP)

5. Preparing & Dispensing (8 s & 34 EP)

6. Adminstering (2 s & 25 EP)

7. Monitoring (2 s & 7 EP)8. High-risk Medication (4 s & 8 EP)

9. Evaluation (1 s & 6 EP)

7.Monitoring(1)

Standard MM.6.10-

The effects of medication(s) on

patients are monitored.

7.Monitoring(2)

Standard MM.6.20-

The hospital responds appropriately

to actual or potential adverse drug

events and medication errors.

Medication Management Standards

1. Patient’s Information (1 s & 3 EP)

2. Selection & Procurement (1 s & 7 EP)

3. Storage (3 s & 24 EP)

4. Ordering & Transcribing (2 s & 13 EP)

5. Preparing & Dispensing (8 s & 34 EP)

6. Adminstering (2 s & 25 EP)

7. 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.7.10-

The hospital develops processes

for managing high-risk or high-

alert medications.

8.High-Risk Medications(2)

Standard MM.7.20-

Psychtropic medication use is

monitored.

8.High-Risk Medications(3)

Standard MM.7.30-

The use of psychopharmacologic

drugs is monitored.

8.High-Risk Medications(4)

Standard MM.7.40-

Investigational medications

are safely controlled and

administered.

Medication Management Standards

1. Patient’s Information (1 s & 3 EP)

2. Selection & Procurement (1 s & 7 EP)

3. Storage (3 s & 24 EP)

4. Ordering & Transcribing (2 s & 13 EP)

5. Preparing & Dispensing (8 s & 34 EP)

6. Adminstering (2 s & 25 EP)

7. Monitoring (2 s & 7 EP)

8. High-risk Medication (4 s & 8 EP)

9. Evaluation (1 s & 6 EP)

9.Evaluation(1)

Standard MM.8.10-

The hospital evaluates its

medication management

system.

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