Når sygeplejersker og farmakonomer er sammen om opgaven

Resume
Baggrund
På grund af et stigende demografisk tryk på sundhedsvæsenet og rekrutteringsvanskeligheder inden for specielt sygeplejen igangsatte Neurologi, Fysio- og Ergoterapi, Neurologisk Sengeafsnit, Regionshospitalet Gødstrup (RHG), et projekt med fokus på at undersøge nye samarbejdsmuligheder mellem Klinisk Farmaci og Neurologisk afdeling.
Formål
At undersøge effekten af samarbejde med farmakonomer målt på patientsikkerhed i forhold til medicinadministration og håndtering, samt aflastning af patientrelaterede opgaver i læge- og plejegruppe på tre kliniske områder: Opfyldning og ajour af medicinposer (patientens medicin på stuen), medicinanamnese, herunder substituering, tilretning i FMK (fællesmedicinkort) og EPJ (Region Midtjyllands elektroniske patientjournal), dispensering (både i forbindelse med indlæggelse og udskrivelse). Metode. Stikprøveundersøgelser, analyse af utilsigtede hændelser (UTH) relateret til medicin over hele prøveperioden, observationsstudier og interviews af personale involveret i den kliniske hverdag.
Resultater
Projektet afdækker administrationsfejl fokuseret mod afstemning af FMK og godkendelse i EPJ med fejlmedicineringer til følge og effekt på andelen af medicinforstyrrelser i afdelingen. De patient-risikofyldte arbejdsgange er primært fundet af farmakonomer i afdelingen til trods for at flere faggrupper var involveret i både administration og udlevering af medicin.
De kvalitative undersøgelser resulterede i fire temaer:
1. Meningsfuld partner
2. Uhensigtsmæssige arbejdstider
3. Udvikling af nye arbejdsgange
4. Den uforventede sparringspartner
Konklusion
Samarbejdet beskrives som meningsfyldt af alle parter. Dog udfordres nye arbejdsgange af de eksisterende rammer. På baggrund af fund i undersøgelsen, konkluderes der, at der i nuværende praksis er risiko for medicinfejl blandt komorbide patienter.

Nøgleord: tværfagligt samarbejde, medicinadministration, opgaveflyt, farmakonomer, kvalitetsforbedring.

English abstract

When nurses and pharmaconomists work together on medication tasks. Exploring interdisciplinary collaboration to improve medication safety and workflows

Background
Due to increasing demographic pressure on the healthcare system and major recruitment challenges in nursing, the Department of Neurology, Physiotherapy and Occupational Therapy and the Neurological Ward at Regionshospitalet Gødstrup initiated a project to explore new forms of collaboration between Clinical Pharmacy and the neurological unit.
Aim
The aim was to investigate the effect of collaborating with pharmaconomists on patient safety related to medication administration and handling, as well as on relieving doctors and nurses of patient‑related tasks in three clinical areas: replenishing and updating in‑room medication bags, medication history including substitution and reconciliation in the Shared Medication Record (FMK) and the electronic health record (EPJ), and dispensing at both admission and discharge.
Methods
The project used sample audits, analysis of all medication‑related adverse events during the study period, observational studies and interviews with staff involved in everyday clinical work.
Results
The project identified administration errors related to reconciliation between FMK and EPJ and subsequent incorrect medication, as well as the impact on the number of medication interruptions in the ward. Risk‑laden workflows were primarily detected by pharmaconomists, despite several professional groups being involved in medication administration and dispensing. Qualitative analyses generated four themes: a meaningful partner, inappropriate working hours, development of new workflows and the unexpected sparring partner.
Conclusion
All parties described the collaboration as meaningful, although existing organisational frameworks challenged the implementation of new workflows. Based on the findings, the study concludes that current practice entails a risk of medication errors among multimorbid patients.

Keywords: Interprofessional collaboration, medication administration, task shifting, pharmaconomists, patient safety, quality improvement, neurology ward.