Variables associated with medication errors in pediatric emergency medicine
Variables associated with medication errors in pediatric emergency medicine
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DOI：
10.1542/peds.110.4.737
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发表时间：
2002-10-01
期刊：
影响因子：
8
通讯作者：
Koren, G
中科院分区：
文献类型：
--
作者：
Kozer, E;Scolnik, D;Koren, G
目标。用药错误是医源性发病和死亡的常见原因。儿科急诊科（EDs）的用药错误发生率尚未被描述。本研究的目的是描述儿科急诊科药物错误的发生率和类型，并确定与错误风险相关的因素。从2000年夏季开始，随机选取12天，对1532名在某儿科三级医院急诊科就诊的儿童进行回顾性队列研究。两名儿科医生，不知道其他研究变量，独立决定是否发生药物错误，并根据严重程度评分对其进行排名。分歧被一致解决了。在10.1%的图表中发现了处方错误。在单因素分析中，以下变量与错误比例增加相关：在上午4点至8点之间就诊的患者（优势比[OR]: 2.45； 95%可信区间[CI]: 1.10-5.50），重症患者（OR: 2.53; 95% CI: 1.18-5.41），实习生开具的药物（OR: 1.48; 95% CI: 1.03-2.11），以及周末就诊的患者（OR: 1.48; 95% CI: 1.04-2.11）。在学员中，学年开始时的错误率较高（OR: 1.67; 95% CI: 1.06-2.64）。逻辑回归显示，当学员（OR: 1.64; 95% CI: 1.06-2.52）和重病患者（OR: 1.55; 95% CI: 1.06-2.26）开药时出错的风险增加。在儿科急诊科，实习医生更容易出现处方错误，而病情最严重的患者更容易出现处方错误。
Objective. Medication errors are a common cause of iatrogenic morbidity and mortality. The incidence of medication errors in pediatric emergency departments (EDs) has not been described. The objective of this study was to describe the incidence and type of drug errors in a pediatric ED and determine factors associated with risk of errors.Methods. A retrospective cohort study was conducted of the charts of 1532 children who were treated in the ED of a pediatric tertiary care hospital during 12 randomly selected days from the summer of 2000. Two pediatricians, blinded to other study variables, independently decided whether a medication error occurred and ranked it according to a severity score. Disagreement was resolved by consensus.Results. Prescribing errors were identified in 10.1% of the charts. The following variables were associated in univariate analysis with an increased proportion of errors: patients seen between 4 AM and 8 AM (odds ratio [OR]: 2.45; 95% confidence interval [CI]: 1.10-5.50), patients with severe disease (OR: 2.53; 95% CI: 1.18-5.41), medication ordered by a trainee (OR: 1.48; 95% CI: 1.03-2.11), and patients seen during weekends (OR: 1.48; 95% CI: 1.04-2.11). Among trainees, there was a higher rate of errors at the beginning of the academic year (OR: 1.67; 95% CI: 1.06-2.64). Logistic regression revealed increased risk for errors when a medication was ordered by a trainee (OR: 1.64; 95% CI: 1.06-2.52) and in seriously ill patients (OR: 1.55; 95% CI: 1.06-2.26).Conclusions. In the pediatric ED, trainees are more likely to commit prescribing errors, and the most seriously ill patients are more likely to be subjected to prescribing errors.