Medication errors and adverse drug events in pediatric inpatients
Medication errors and adverse drug events in pediatric inpatients
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DOI：
10.1001/jama.285.16.2114
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发表时间：
2001-04-25
影响因子：
120.7
通讯作者：
Goldmann, DA
中科院分区：
文献类型：
--
作者：
Kaushal, R;Bates, DW;Goldmann, DA
背景医源性损伤，包括用药错误，是所有住院人群的一个重要问题。然而，很少有流行病学数据是关于用药错误在儿科住院setting.Objectives评估率的用药错误，药物不良事件（ADEs），和潜在的ADEs;比较儿童率与以前报道的成人率;分析主要类型的错误;并评估预防战略的潜在影响。设计，设置，1999年4月和5月，对1120名在2个学术机构住院的患者进行了为期6周的前瞻性队列研究。主要结果测量用药错误，潜在的ADE，结果10778张医嘱中发现用药错误616张（5.7%），潜在ADE 115张（1.1%），ADE 26张（0.24%）。在26例ADE中，5例（19%）是可以预防的。虽然可预防的ADE发生率与之前的成人医院研究相似，但潜在ADE发生率高出3倍。新生儿重症监护室的新生儿潜在ADE发生率显著较高。大多数潜在的ADE发生在药物订购阶段（79%），涉及不正确的剂量（34%），抗感染药物（28%）和静脉给药（54%），医师评审员判断，计算机医嘱输入可能预防了93%的潜在ADE，病房临床药师可能预防了94%的潜在ADE。需要进一步努力减少这些风险。
Context latrogenic injuries, including medication errors, are an important problem in all hospitalized populations. However, few epidemiological data are available regarding medication errors in the pediatric inpatient setting.Objectives To assess the rates of medication errors, adverse drug events (ADEs), and potential ADEs; to compare pediatric rates with previously reported adult rates; to analyze the major types of errors; and to evaluate the potential impact of prevention strategies.Design, Setting, and Patients Prospective cohort study of 1120 patients admitted to 2 academic institutions during 6 weeks in April and May of 1999.Main Outcome Measures Medication errors, potential ADEs, and ADEs were identified by clinical staff reports and review of medication order sheets, medication administration records, and patient charts.Results We reviewed 10778 medication orders and found 616 medication errors (5.7%), 115 potential ADEs (1.1%), and 26 ADEs (0.24%). Of the 26 ADEs, 5 (19%) were preventable. While the preventable ADE rate was similar to that of a previous adult hospital study, the potential ADE rate was 3 times higher. The rate of potential ADEs was significantly higher in neonates in the neonatal intensive care unit. Most potential ADEs occurred at the stage of drug ordering (79%) and involved incorrect dosing (34%), anti-infective drugs (28%), and intravenous medications (54%), Physician reviewers judged that computerized physician order entry could potentially have prevented 93% and ward-based clinical pharmacists 94% of potential ADEs.Conclusions Medication errors are common in pediatric inpatient settings, and further efforts are needed to reduce them.