Zhongguo quanke yixue (Oct 2022)
Application of TeamSTEPPS in the Management of Out-of-hospital Medication Safety for Patients with Chronic Heart Failure
Abstract
Background Due to long treatment cycle and medication dependence, patients with chronic heart failure (CHF) face many risks of out-of-hospital medication. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based patient safety tool, which has been studied rarely in the management of out-of-hospital medication safety in CHF patients. Objective To discuss the role of TeamSTEPPS in the out-of-hospital medication safety management in CHF patients. Methods A total of 134 CHF patients hospitalized in the First Affiliated Hospital of Chongqing Medical University from June 2019 to June 2020 were selected, and were divided into the intervention group (n=62) and control group (n=61) according to the number of ward, receiving routine medication safety management, and TeamSTEPPS-based medication safety management, respectively. The medication error was evaluated before discharge and 6 months after discharge by the Medication Error Questionnaire developed by us. The medication knowledge, attitude and practice (KAP) were evaluated before discharge, 1, 3 and 6 months after discharge by a self-developed Medication KAP Scale. Cardiac function, dyspnea and edema were evaluated before discharge, 3 and 6 months after discharge. The readmission and all-cause mortality were collected 3 and 6 months after discharge. The safety attitude of medical workers was measured before intervention and 6 months after intervention by the Chinese version of the Safety Attitudes Questionnaire (SAQ-C) . Results The prevalence of ignoring the content of the prescription, omission error, wrong time error, wrong dose error, taking medication without a doctor's advice and unauthorized drug withdrawal differed between the two groups 6 months after discharge (P<0.05) . The readmission rates of the intervention group 3 and 6 months after discharge were lower than those of the control group (P<0.05) . The scores of teamwork climate, safety climate, perceptions of management, job satisfaction and stress recognition in medical workers providing services for the intervention group 6 months after intervention were higher than those before intervention (P<0.05) . The results of two-factor repeated measures ANOVA showed that the duration and type of medication safety management had significant interaction effects on the medication KAP scores, NYHA class, dyspnea and edema in two groups (P<0.05) . The duration of medication safety management had an significant main effect on the medication KAP scores, dyspnea and edema in two groups (P<0.05) . The type of medication safety management had a significant main effect on the medication KAP and edema in two groups (P<0.05) . The medication knowledge scores of the intervention group 3 and 6 months after discharge were higher than those of the control group (P<0.05) . The intervention group had higher medication attitude score but lower medication practice score than the control group 1, 3 or 6 months after discharge (P<0.05) . The medication knowledge and medication attitude scores increased in both groups 1, 3, 6 months after discharge (P<0.05) . The medication practice score increased in the intervention group 1, 3, 6 months after discharge, but decreased in the control group at 1 month after discharge (P<0.05) . The medication knowledge score at 1 month after discharge was lower than that 3 or 6 months after discharge in the intervention group (P<0.05) , but the opposite was found in the control group (P<0.05) . The dyspnea score at 6 months after discharge was lower than that before discharge in the intervention group (P<0.05) . The edema score before discharge was higher than that 3 and 6 months after discharge in the intervention group (P<0.05) . The intervention group had higher edema score 3 and 6 months after discharge than the control group (P<0.05) . Conclusion The use of TeamSTEPPS in out-of-hospital medication safety management in CHF patients could improve the medication safety and symptoms in patients as well as enhance the safety culture of the healthcare team.
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