Establishment of the prescribing procedure for a nurse practitioner as assistant to a physician

• Main Authors: Chiang, Po-Yi, 江柏逸
• Other Authors: Wanh, Eric Min-Yang
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/h7zwz5

碩士 === 國立清華大學 === 工業工程與工程管理學系 === 107 === Medication-use process, which contains prescribing, dispensing and administration, involves in multidisciplinary professional and complexity. Any steps in the process could be result in error. According to the 2016 annual report of Taiwan patient safety system, it indicated adverse drug event accounted for the most percentage of all categories, and also it mostly occurred in the prescribing stage. However, previous researches about prescribing error focused on improving interface of computerized physician order system and less than on investigating the problems in the process. In addition, inpatient prescribing procedure is majorly assisted by nurse practitioner which start with rounding, helping with prescribing and typing in prescription and confirming by the physician. Therefore, this study would investigate the prescribing procedure for a nurse practitioner as assistant to a physician, and establish preliminary standard operating procedure in order to reduce numbers of adverse drug events. The study consist of three stages. The first stage is to examine the existing clinical process and cooperate with five experts in order to identify failure modes and root causes by integrating healthcare failure mode and effect analysis with human factors analysis and classification system. The second stage is to establish preliminary standard operating procedure by using human factors principles for patient safety. The study design ward round template for nurse practitioner and add several readback steps in preliminary standard operating procedure. In the third stage, preliminary standard operating procedures was validated by using simulated- task experiment and four outcome measures of satisfaction, mental workload, accuracy and operating time. The result shows mental workload and operating time were not significantly different with each other. But, satisfaction and accuracy have significant difference. It is represented that preliminary standard operating procedure could effectively prevent errors and be more suitable for nurse practitioner. It is expected that the results of failure modes, root causes and preliminary standard operating procedure could be used as reference for medical institutions in order to eliminate occurrence of adverse drug event and improve the patient safety.