HİZMET KALİTE STANDARTLARI VERSİYON 4 VE VERSİYON 5’İN HASTANELERDE İLAÇ GÜVENLİĞİ AÇISINDAN KARŞILAŞTIRILMASI

Yıl 2016, Cilt: 5 Sayı: 2, 69 - 74, 31.08.2016

Elif Aksöz , Oğuzhan Korkut

Öz

GİRİŞ ve AMAÇ: Hastanelerde ilaçla ilişkili problemler artık dünya çapında endişe uyandırmaktadır. TC Sağlık Bakanlığı hastaneler tarafından sağlanan sağlık kalitesini artırmak ve değerlendirmek için, bir rehber kitap üretmiştir: Hastane Hizmet Kalite Standartları. Rehber yıllar içinde güncellenmiş ve 2015 yılında Versiyon 5 yayımlanmıştır. Birçok başka konuya ek olarak rehber, ilaç güvenliği hakkında da bilgi içermektedir. Bu çalışmanın amacı, hastanelerde ilaç güvenliği açısından Versiyon 4 ve Versiyon 5’i karşılaştırmaktır.

YÖNTEM ve GEREÇLER: Her iki rehber de ilaçla ilgili bilgiler için tarandı. İlaçla ilgili maddeler saptanarak 6 ana başlık altında sınıflandırıldı (muhafaza, doktor istemi, hazırlama ve transfer, uygulama ve izlem, eğitim, düzenlemeler) ve ilgili literatür ışığında değerlendirildi.

BULGULAR: Toplamda, Versiyon 4 içeriğinin %15,15’i ilaçla ilişkiliydi; ayrıca, ilaçla ilişkili kalite puanları hastane personeline dağıtılan ödemeleri % 15’lere varan oranlarda etkilemekteydi. Bununla beraber, Versiyon 5 içeriğinin %6,64’ü ilaçla ilişkiliydi; ve ilgili kalite puanları hastane personeline dağıtılan ödemeleri sadece %7,84 oranında etkilemekteydi.

TARTIŞMA ve SONUÇ: Versiyon 5’te ilaç güvenliği standartları daha düzenli ve geliştirilmiş olmasına rağmen, bu standartlar için ayrılan puanların genel hastane kalite puanlarına etkisi Versiyon 4’ün sadece yarısı kadar olduğundan ve bu da personelin ek ödemelerinde azalma ile sonuçlandığından, uygulamada V5, V4 kadar etkili olmayabilir. Öte yandan, her iki rehber de hastanelerde ilaç güvenliğini sağlamak için yararlı araçlar gibi görünmektedir.

Anahtar Kelimeler

İlaçla ilişkili problemler, İlaç Güvenliği, İlaç Hataları, Hastaneler

A COMPARISON OF THE VERSION 4 AND VERSION 5 SERVICE QUALITY STANDARDS IN TERMS OF THE MEDICATION SAFETY IN HOSPITALS

Öz

INTRODUCTION: Drug-related problems (DRPs) in hospitals represent a worldwide concern nowadays. To evaluate and improve the quality of healthcare provided by hospitals, the Ministry of Health of Turkey produced a guidebook; The Hospital Service Quality Standards. The guidebook has been updated in years and Version 5 was published in 2015. In addition to numerous other topics, the guidebook contains information on medication safety. The aim of this study was to compare the Version 4 with the Version 5 in terms of drug safety.

METHODS: Both guidebooks were reviewed for drug related information. Drug-related sections were determined and classified under the following six main headings (storage, physician orders, preparation and transfer, implementation and monitoring, training and regulations) and evaluated with the relevant literature.

RESULTS: In total, 15,15% of the contents of the version 4 were drug-related; furthermore, drug-related quality scores affected the payments distributed to hospital personnel by up to 15%. However, 6,64 % of the contents of the version 5 were drug-related; and related scores affected the payments distributed to hospital personnel by just 7,84%.

DISCUSSION AND CONCLUSION: The impact of the scores allocated to drug safety on the overall hospital quality scores in version 5 was the only half of version 4. Therefore, V5 may not be as effective as V4. On the other hand, both guidebooks appear to be useful tools for ensuring medication safety in hospitals.

Anahtar Kelimeler

Drug-related problems, Medication Safety, Medication Errors, Hospitals

Kaynakça

• 1. Classification for Drug related problems V5.01. Pharmaceutical Care Network Europe (PCNE). 2006. http://www.pcne.org/upload/files/16_PCNE_classification_V5.01.pdf (Erişim:04.01.2016)
• 2. Mehta S, Gogtay NJ. From the pen to the patient: minimising medication errors. J Postgrad Med. 2005;51:3-4.
• 3. Kohn LT, Corrigan JM, Donaldson MS. To Err Is Human: Building a Safer Health System,s.26-27, The National Academy Press.,Washington,DC (2000).
• 4. Bootman JL, Wolcott J, Aspden P, Cronenwett LR. Preventing Medication Errors: Quality Chasm Series,s.5, The National Academies Press., Washington,DC (2006).
• 5. Basger BJ, Moles RJ, Chen TF. Application of drug-related problem (DRP) classification systems: a review of the literature. Eur J Clin Pharmacol. 2014;70:799-815.
• 6. Aronson JK. Medication errors: definitions and classification. Br J Clin Pharmacol. 2009;67:599-604.
• 7. Lampert ML, Kraehenbuehl S, Hug BL. Drug-related problems: evaluation of a classification system in the daily practice of a Swiss University Hospital. Pharm World Sci .2008;30:768-76.
• 8. Morimoto T, Gandhi TK, Seger AC, Hsieh TC, Bates DW. Adverse drug events and medication errors: detection and classification methods. Qual Saf Health Care.2004;13:306-14.
• 9. Pintor-Mármol A, Baena MI, Fajardo PC, et al.Terms used in patient safety related to medication: a literature review. Pharmacoepidemiol Drug Saf. 2012;21:799-809.
• 10. Yun IS, Koo MJ, Park EH, et al. A comparison of active surveillance programs including a spontaneous reporting model for phamacovigilance of adverse drug events in a hospital. Korean J Intern Med. 2012;27:443-50.
• 11. Stausberg J, Hasford J. Drug-related admissions and hospital-acquired adverse drug events in Germany: a longitudinal analysis from 2003 to 2007 of ICD-10-coded routine data. BMC Health Serv Res. 2011;11:134.
• 12. Sağlıkta Kalite Standartları (SKS)-Hastane (Versiyon-5), Sağlık Hizmetleri Genel Müdürlüğü Sağlıkta Kalite ve Akreditasyon Daire Başkanlığı Ankara, 2015. https://kalite.saglik.gov.tr/content/files/duyurular_2011/2011/2014/sks_hastane_versiyon_5_08.07.2015.pdf (Erişim:04.01.2016)
• 13. İlaç Güvenliği Rehberi (Versiyon 2.0 ; Revizyon 00) 2.Baskı, Sağlık Hizmetleri Genel Müdürlüğü Sağlıkta Kalite ve Akreditasyon Daire Başkanlığı Ankara, 2015 https://kalite.saglik.gov.tr/content/files/2015/Ilac_Guvenligi_Rehberi.pdf (Erişim:04.01.2016)
• 14. SKS ve İlaç Güvenliği, Sağlık Hizmetleri Genel Müdürlüğü Sağlıkta Kalite ve Akreditasyon Daire Başkanlığı Ankara, 2012. https://kalite.saglik.gov.tr/content/files/duyurular_2011/2011/2013/igrehberi.pdf (Erişim:04.01.2016)
• 15. SHKS-HASTANE SETİ (Versiyon 4) Sağlık Hizmetleri Genel Müdürlüğü Sağlıkta Kalite ve Akreditasyon Daire Başkanlığı Ankara, 2011. https://kalite.saglik.gov.tr/content/files/duyurular_2011/2011/2014/ek1shkshastaneversiyon4.pdf (Erişim:04.01.2016)
• 16. Nakyanzi JK, Kitutu FE, Oria H, et al. Expiry of medicines in supply outlets in Uganda. Bull World Health Organ. 2010;88:154-8.
• 17. Keers RN, Williams SD, Cooke J, et al. Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug Saf. 2013;36:1045-67.
• 18. Tawfik KA, Jabeen A. Pharmaceuticals safety practices-a comparative pilot study. Int J Health Sci.2013;7:317-24.
• 19. Cohen V, Jellinek SP, Teperikidis L, et al. Room-temperature storage of medications labeled for refrigeration. Am J Health Syst Phar. 2007;64:1711-5.
• 20. Aljadhey H, Alhusan A, Alburikan K, et al. Medication safety practices in hospitals: A national survey in Saudi Arabia. Saudi Pharm J. 2013;21:159-64.
• 21. Mattison ML, Afonso KA, Ngo LH, et al. Preventing potentially inappropriate medication use in hospitalized older patients with a computerized provider order entry warning system. Arch Intern Med. 2010;170:1331-6.
• 22. Tully MP, Ashcroft DM, Dornan T, et al. The causes of and factors associated with prescribing errors in hospital inpatients: a systematic review. Drug Saf. 2009;32:819-36.
• 23. Velo GP, Minuz P. Medication errors: prescribing faults and prescription errors. Br J Clin Pharmacol.2009;67:624-8.
• 24. Garbutt JM, DeFer TM, Highstein G, et al. Safe prescribing: an educational intervention for medical students. Teach Learn Med. 2006;18:244-50.
• 25. Benjamin DM. Reducing medication errors and increasing patient safety: case studies in clinical pharmacology. J Clin Pharmacol. 2003;43:768-83.
• 26. Durán-García E, Fernandez-Llamazares CM, Calleja-Hernández MA. Medication reconciliation: passing phase or real need? Int J Clin Pharm. 2012;34:797-802.
• 27. Kramer JS, Hopkins PJ, Rosendale JC, et al. Implementation of an electronic system for medication reconciliation. Am J Health Syst Pharm. 2007;64:404-22.
• 28. Ostini R, Roughead EE, Kirkpatrick CM, et al. Quality Use of Medicines--medication safety issues in naming; look-alike, sound-alike medicine names. Int J Pharm Pract. 2012;20:349-57.
• 29. Lefkovitz A, Zarowitz B. Top 10 lists - medications associated with adverse events and medications involved with errors. Geriatr Nurs. 2007;28:276-9.
• 30. Gunningberg L, Pöder U, Donaldson N, et al. Medication administration accuracy: using clinical observation and review of patient records to assess safety and guide performance improvement. J Eval Clin Prac. 2014;20:411-6.
• 31. Wright K. Do calculation errors by nurses cause medication errors in clinical practice? A literature review. Nurse Educ Today.2010;30:85-97.
• 32. Barker KN, Flynn EA, Pepper GA, et al. Medication errors observed in 36 health care facilities. Arch Intern Med. 2002;162:1897-903.
• 33. Alsulami Z, Choonara I, Conroy S. Nurses' knowledge about the double-checking process for medicines administration. Nurs Child Young People. 2014;26:21-6.
• 34. Simonsen BO, Daehlin GK, Johansson I, et al. Differences in medication knowledge and risk of errors between graduating nursing students and working registered nurses:comparative study. BMC Health Serv Res. 2014;14:580.
• 35. Tervo-Heikkinen T, Partanen P, Aalto P, et al. Nurses' work environment and nursing outcomes: a survey study among Finnish university hospital registered nurses. Int J Nurs Pract. 2008;14:357-65.
• 36. Kang JH, Kim CW, Lee SY. Nurse-perceived patient adverse events and nursing practice environment. J Prev Med Public Health. 2014;47:273-80.
• 37. O'Malley PA. Preventing and reporting adverse drug events: pharmacovigilance for the clinical nurse specialist. Clin Nurse Spec. 2012;26:136-7.
• 38. Borg JJ, Aislaitner G, Pirozynski M, et al. Strengthening and rationalizing pharmacovigilance in the EU: where is Europe heading to? A review of the new EU legislation on pharmacovigilance. Drug Saf. 2011;34:187-97.
• 39. Food Safety and PublicHealth Situation inTurkey. European Parliament website. 2011. http://www.europarl.europa.eu/document/activities/cont/201111/20111111ATT31265/20111111ATT31265EN.pdf (Erişim:04.01.2016).
• 40. Mueller SK, Sponsler KC, Kripalani S, et al. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012;172:1057-69.
• 41. Viktil KK, Blix HS. The impact of clinical pharmacists on drug-related problems and clinical outcomes. Basic Clin Pharmacol Toxicol. 2008;102:275-80.
• 42. Hohmann C, Eickhoff C, Klotz JM, et al. Development of a classification system for drug-related problems in the hospital setting (APS-Doc) and assessment of the inter-rater reliability. J Clin Pharm Ther. 2012;37:276-81.
• 43. Bondesson A, Eriksson T, Kragh A, et al. In-hospital medication reviews reduce unidentified drug-related problems. Eur J Clin Pharmacol. 2013;69:647-55.