Preventing Iatrogenic Overdose: A Review of In Emergency Department Opioid-Related Adverse Drug Events and Medication Errors
Preventing Iatrogenic Overdose: A Review of In Emergency Department Opioid-Related Adverse Drug Events and Medication Errors
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DOI：
10.1016/j.annemergmed.2014.11.016
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发表时间：
2015-04-01
影响因子：
6.2
通讯作者：
Babu, Kavita M.
中科院分区：
文献类型：
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作者：
Beaudoin, Francesca L.;Merchant, Roland C.;Babu, Kavita M.
研究目的：我们描述急诊科（ED）阿片类药物相关不良事件、用药错误以及用药错误造成的伤害的患者特征；识别与急诊室阿片类药物相关用药错误和伤害相关的患者、提供者和系统因素；并制定一份预防未来事件发生的策略清单。方法：这项回顾性研究是在 2 个城市学术 ED 进行的。通过查询急诊室电子病历中在急诊室施用阿片类药物后施用纳洛酮的病例，确定了潜在的医源性阿片类药物过量。对涉及导致伤害的用药错误的病例进行了定性审查，以了解可能导致该事件的常见患者、提供者和系统因素。结果：在 73 名急诊科患者中，发生与急诊科内阿片类药物相关的不良事件，需要用纳洛酮逆转，其中 43 名患者因用药错误而导致伤害。可能导致这些事件的基于患者、提供者和系统的因素包括可能使个人容易发生阿片类药物相关不良事件的慢性健康状况、未能调整老年人和肝肾功能不全的阿片类药物剂量、阿片类药物的多剂量和给药途径、阿片类药物与其他镇静药物的共同给药，以及基于系统的患者交接和药房监督问题。结论：我们确定了患者、提供者和药房监管方面的问题。接受纳洛酮的 ED 患者中与阿片类药物相关不良药物事件和用药错误相关的基于系统的因素。我们的评估结果可用于为旨在预防急诊科内阿片类药物相关不良药物事件和用药错误的教育和政策举措提供信息。
Study objective: We describe characteristics of patients with in-emergency department (ED) opioid-related adverse drug events, medication errors, and harm resulting from medication errors; identify patient-, provider-, and system-based factors associated with in-ED opioid-related medication errors and harm; and create a list of strategies to prevent future events.Methods: This retrospective study was conducted at 2 urban academic EDs. Potential iatrogenic opioid overdoses were identified by querying the ED electronic medical record for cases when naloxone was administered after an opioid was administered in the ED. Cases involving medication errors resulting in harm were reviewed qualitatively for common patient-, provider-, and systems-based factors that might have contributed to the event.Results: Of 73 ED patients with in-ED opioid-related adverse events that required reversal with naloxone, 43 had a medication error resulting in harm. Patient-, provider-, and systems-based factors that might have contributed to the events included chronic health conditions that could predispose an individual to an opioid-related adverse event, failure to adjust opioid dosing in the elderly and for hepatic or renal impairment, multiple doses and routes of administration of opioids, coadministration of opioids with other sedating medications, and systems-based problems with patient handoffs and pharmacy oversight.Conclusion: We identified patient-, provider-, and systems-based factors related to opioid-related adverse drug events and medication errors among ED patients who had received naloxone. The results from our assessment can be used to inform educational and policy initiatives aimed to prevent in-ED opioid-related adverse drug events and medication errors.