استانداردهاي JCAHO در تجويز و مصرف دارو در بيمارستان دكتر شهرام توفيقي MD.PhD همايش خطاهاي پزشكي خرم آباد ارديبهشت 1384

JCAHO Joint Comission on Accredtion of Health Organizations كميسيون مشترك اعتبار بخشي به سازمان هاي بهداشتي ودرماني

انستيتوي پزشكي Institute of Medicine (IOM) در سال 2000 گزارشي منتشر كرد به نام: To Err Is Human: Building Safe Health در اين گزارش وضعيت تجويز و مصرف دارو در بيمارستان هاي امريكا مورد بررسي و تحليل قرار گرفت. بر اساس اين گزارش سالانه حدود نفر از تجويز نابجاي دارو آسيب ديده و حدود نفر مي ميرند.

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 CPOE Computerized 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 1.انتخاب و تامين selction & procurement 2.انبارش storage 3.دستور دهي و ترا نويسيtranscribing oredering & 4.آماده سازي و نسخه پيچيpreparation & dispensing 5.مصرف administration 6.پايش باليني اثرات clinical monitiring of effects

مقدمه آنچه در متن راهنماي استاندارد آمده : گزاره استاندارد عناصر عملكردي Performance Elements of امتيازدهي به هر EP فعاليت هايي كه براي بررسي ميزان انطباق وضعيت با استانداردها انجام مي شود. استانداردها در 9 دسته و24 گزاره استاندارد و 127 عنصر عملكردي ارائه شده اند.

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 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 Medications are properly and safely stored throughout the hospital.

3.Storage (2) Standard MM 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 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 Only medications needed to treat the patient’s condition are ordered.

Standard MM 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 All prescriptions or medication orders are reviewed for appropriateness.

5.Preparing & Dispensing (2) Standard MM Medications are prepared safely.

5.Preparing & Dispensing (3) Standard MM Medications are appropriately labeled.

5.Preparing & Dispensing (4) Standard MM Medications are dispensed safely.

5.Preparing & Dispensing (5) Standard MM 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 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 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 Medications are safely and accurately administered.

6.Administering (2) Standard MM 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 The effects of medication(s) on patients are monitored.

7.Monitoring (2) Standard MM 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 The hospital develops processes for managing high-risk or high- alert medications.

8.High-Risk Medications (2) Standard MM Psychtropic medication use is monitored.

8.High-Risk Medications (3) Standard MM The use of psychopharmacologic drugs is monitored.

8.High-Risk Medications (4) Standard MM 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 The hospital evaluates its medication management system.

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