Variability in Intravenous Medication Practices: Implications for Medication Safety
Variability in Intravenous Medication Practices: Implications for Medication Safety
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DOI：
10.1016/s1553-7250(05)31026-9
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发表时间：
2005-04-01
影响因子：
2.3
通讯作者：
Rothschild, Jeffrey
中科院分区：
文献类型：
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作者：
Bates, David W.;Vanderveen, Timothy;Rothschild, Jeffrey
背景：输液设备可以根据各个医院的静脉（IV）给药“最佳实践”规则进行编程，如果剂量超出预先设定的限制，则可以发出警报。高变异水平在医疗保健中很常见，但如果不必要的变异可能会增加安全风险。方法：对来自 100 家医院使用一家制造商的输液设备的药物 IV 最佳实践数据集进行比较，以评估所用药物名称的数量以及浓度、剂量单位、剂量限制和给药实践的变化。结果：100 家医院每个数据集平均显示 64 种药物，平均显示 113 种不同的药物/浓度组合。平均而言，每家医院都指定了 6 个类别或独特的患者护理区域；各医院的每种药物有 4 个不同的名称（例如胺碘酮有 45 个不同的名称）。浓度的高水平变化是普遍存在的。总体而言，60% 的药物具有多个连续剂量单位（范围 1-9）。推注剂量也存在差异； 119 种药物中有 59 种 (50%) 具有超过 1 个单位（范围 1-4）。剂量限制也有很大差异，但很难评估，因为剂量限制通常随适应症的不同而变化。结论：静脉注射药物实践中的大量不必要的变化可能与伤害风险增加有关。标准化有可能大幅提高静脉注射药物的安全性。
Background: Infusion devices can be programmed with individual hospitals' "best practice" rules for intravenous (IV) drug administration, and alerts can be provided if dosages fall outside pre-established limits. High variation levels are common in medical care but can increase safety risk if the variation is unnecessary.Methods: The IV best practice data sets of drugs from 100 hospitals using one manufacturer's infusion devices were compared to assess the number of drug names used and the variation in concentrations, dose units, dose limits, and administration practices.Results: The 100 hospitals showed an average of 64 drugs per data set and an average of 113 different drug/concentration combinations. On average, each hospital had designated 6 profiles or unique patient care areas; there were 4 different names per drug across the hospitals (for example, amiodarone had 45 different names). High levels of variation in concentrations were ubiquitous. Overall, 60% of medications had more than one continuous dosage unit (range, 1-9). Variation was also noted in bolus dosing; 59 (50%) of 119 drugs had more than one unit (range, 1-4). Dose limits also varied substantially but were difficult to assess since the limits typically varied with the indication.Conclusions: Substantial unnecessary variation in IV medication practices is likely associated with increased risk of harm. Standardization has the potential to substantially improve IV medication safety.