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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