Page 60 - 中国全科医学2022-30

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3.Nursing Department，the First Branch of the First Affiliated Hospital of Chongqing Medical University，Chongqing 400016，
China
4.Department of Urology，the First Affiliated Hospital of Chongqing Medical University，Chongqing 400016，China
*
Corresponding author：WANG Fulan，Chief superintendent nurse；E-mail：WFL3076@163.com
【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.
【Key words】 Heart failure；TeamSTEPPS；Cardiovascular diseases；Medication safety；Follow-up studies

慢性心力衰竭（chronic heart failure，CHF）具有高 质量下降甚至危及患者生命。2017 年，世界卫生组织
发病率、反复入院、老年患者占比高、预后差等特点 ［1］ ， （WHO）启动了“药无伤害”项目 ［2］ ，旨在降低严重
安全合理用药能够有效控制患者心力衰竭症状，预防和 可避免的药物相关危害。加强临床表现和医疗安全的团
抑制心肌重构，从而延缓疾病进程，减少心力衰竭复发， 队策略与工具包（TeamSTEPPS）是在循证基础上开展
延长患者生存期。由于 CHF 病程迁延，患者用药过程 的一种患者安全工具 ［3］ ，能够有效改善医疗团队合作、
中存在不同医院、家庭与医院、门诊与病房之间等诸多 构建医疗团队安全文化氛围、提升医疗团队合作技能、
环节脱节的情况，可能会增加患者用药风险，影响治疗 减少医疗差错、降低不良事件发生率。为了保障患者院
质量，导致患者短期内反复入院、心功能恶化、生活 外用药安全，本研究采用 TeamSTEPPS 培训心力衰竭管