Medication audit and feedback by a clinical pharmacist decrease medication errors at the PICU: An interrupted time series analysis
Medication audit and feedback by a clinical pharmacist decrease medication errors at the PICU: An interrupted time series analysis
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DOI：
10.1002/hsr2.23
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发表时间：
2018-03-01
影响因子：
2
通讯作者：
Geukers, Vincent G. M.
中科院分区：
文献类型：
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作者：
Maaskant, Jolanda M.;Tio, Marieke A.;Geukers, Vincent G. M.
目的：用药错误（ME）是住院患者中最常见的不良事件之一，对儿童的危害可能大于成人。为了提高用药安全性，我们研究了结构化的药物审计和反馈的临床药师作为多学科团队的一部分，对ME在危重children.Method：我们进行了一个中断的时间序列分析与6干预前和6干预后的数据收集点，在三级儿科重症监护病房。我们纳入了2013年7月至12月（干预前）和2014年7月至12月（干预后）收治的重症监护患者。主要终点是每100张处方的ME患病率。我们审查了患者的临床记录和ME的事件报告系统。如果怀疑ME，则由儿科重症监护医师和临床药剂师确定因果关系和可预防性。他们归类为有害的ME根据全国协调理事会的用药错误报告和预防categories.Results：我们包括254例患者在干预前期间和230例患者在干预后期间。我们在干预前阶段确定了153个ME，对应于每100张处方中的2.27个，在干预后阶段确定了90个ME，对应于每100张处方中的1.71个。自回归积分移动平均分析显示干预前后斜率有显著变化（β =-0.21，95%CI，-0.41 ~-0.02，P = 0.04）。我们没有观察到一个显着的减少后立即开始干预（β =-0.61，95%CI，-1.31至0.08; P = 0.07）。结论：实施结构化的药物审计，然后由临床药师作为多学科团队的一部分反馈，导致在一个显着减少ME在三级儿科重症监护病房。
Objective: Medication errors (MEs) are one of the most frequently occurring types of adverse events in hospitalized patients and potentially more harmful in children than in adults. To increase medication safety, we studied the effect of structured medication audit and feedback by a clinical pharmacist as part of the multidisciplinary team, on MEs in critically ill children.Method: We performed an interrupted time series analysis with 6 preintervention and 6 post-intervention data collection points, in a tertiary pediatric intensive care unit. We included intensive care patients admitted during July to December 2013 (preintervention) and July to December 2014 (postintervention). The primary endpoint was the prevalence of MEs per 100 prescriptions. We reviewed the clinical records of the patients and the incident reporting system for MEs. If an ME was suspected, a pediatrician-intensivist and a clinical pharmacist determined causality and preventability. They classified MEs as harmful according to the National Coordinating Council for Medication Error Reporting and Prevention categories.Results: We included 254 patients in the preintervention period and 230 patients in the postintervention period. We identified 153 MEs in the preintervention period, corresponding with 2.27 per 100 prescriptions, and 90 MEs in the postintervention period, corresponding with 1.71 per 100 prescriptions. Autoregressive integrated moving average analyses revealed a significant change in slopes between the preintervention and postintervention periods (beta = -.21; 95% CI, -0.41 to -0.02; P = .04). We did not observe a significant decrease immediately after the start of the intervention (beta = -.61; 95% CI, -1.31 to 0.08; P = .07).Conclusion: The implementation of a structured medication audit, followed by feedback by a clinical pharmacist as part of the multidisciplinary team, resulted in a significant reduction of MEs in a tertiary pediatric intensive care unit.