Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients
Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients
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DOI：
10.1542/peds.111.4.722
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发表时间：
2003-04-01
期刊：
影响因子：
8
通讯作者：
Bates, DW
中科院分区：
文献类型：
--
作者：
Fortescue, EB;Kaushal, R;Bates, DW
目标.儿科住院患者的用药错误发生率与成人相似，但造成伤害的可能性是成人的3倍。在这种情况下，错误预防策略在很大程度上仍然未经测试。本研究的目的是对儿科住院患者的主要用药错误类型进行分类，并确定哪些策略可能最有效地预防它们。对1999年4月和5月在2个学术医疗中心住院的1020例患者进行了为期6周的前瞻性队列研究。用药错误的特点是亚型。医生评估者评估了错误预防策略，并确定了那些可能是最有效的预防错误。在审查的10778份医嘱中，616份包含错误。其中，120例（19.5%）被归类为潜在有害，包括115例潜在药物不良事件（18.7%）和5例可预防的药物不良事件（0.8%）。大多数错误发生在订购阶段（74%），涉及剂量（28%），途径（18%）或频率（9%）的错误。三种干预措施可能防止了最可能有害的错误：1）计算机化的医嘱输入与临床决策支持系统（76%）; 2）基于病房的临床药剂师（81%）;和3）改善医生，护士和药剂师之间的沟通（86%）。错误预防策略分配的评定者间信度良好（一致性：0.92; kappa：0.82）。在所评估的干预措施中，计算机化医嘱输入与临床决策支持系统;以病房为基础的临床药剂师;以及改善医生、护士和药剂师之间的沟通，最有可能减少儿科住院患者的用药错误。需要在儿科住院环境中制定、实施和评估此类干预措施。
Objectives. Medication errors in pediatric inpatients occur at similar rates as in adults but have 3 times the potential to cause harm. Error prevention strategies in this setting remain largely untested. The objective of this study was to classify the major types of medication errors in pediatric inpatients and to determine which strategies might most effectively prevent them.Methods. A prospective cohort study was conducted of 1020 patients who were admitted to 2 academic medical centers during a 6-week period in April and May 1999. Medication errors were characterized by subtype. Physician raters evaluated error prevention strategies and identified those that might be most effective in preventing errors.Results. Of 10 778 medication orders reviewed, 616 contained errors. Of these, 120 (19.5%) were classified as potentially harmful, including 115 potential adverse drug events (18.7%) and 5 preventable adverse drug events (0.8%). Most errors occurred at the ordering stage (74%) and involved errors in dosing (28%), route (18%), or frequency (9%). Three interventions might have prevented most potentially harmful errors: 1) computerized physician order entry with clinical decision support systems (76%); 2) ward-based clinical pharmacists (81%); and 3) improved communication among physicians, nurses, and pharmacists (86%). Interrater reliability of error prevention strategy assignment was good (agreement: 0.92; kappa: 0.82).Conclusions. Of the assessed interventions, computerized physician order entry with clinical decision support systems; ward- based clinical pharmacists; and improved communication among physicians, nurses, and pharmacists had the greatest potential to reduce medication errors in pediatric inpatients. Development, implementation, and assessment of such interventions in the pediatric inpatient setting are needed.