Dean B S, Barber N D
Centre for Pharmacy Practice, School of Pharmacy, London University, England.
Am J Health Syst Pharm. 1999 Jan 1;56(1):57-62. doi: 10.1093/ajhp/56.1.57.
A method of scoring the severity of medication errors that does not require knowledge of patient outcomes was developed and tested. Thirty health care professionals from four U.K. hospitals scored 50 medication errors in terms of potential patient outcomes on a scale of 0 to 10, where 0 represented a case with no potential effect and 10 a case that would result in death. Sixteen error cases reported in the literature with actual patient outcomes were included among the cases to assess the validity of the scores. Ten of the errors were scored twice. The severity of the error cases, the occasion on which they were scored, the judge, each judge's profession, and the interactions between these were considered as potential sources of variability in scoring. The data were analyzed by applying generalizability theory to two models: one based on the 10 cases that were scored twice and ignoring the effect of differences in profession and one based on all 50 cases and ignoring the effect of the occasion of scoring. Generalizability coefficients for different numbers of judges and scoring occasions were calculated. A generalizability coefficient of 0.8 or more was considered to represent acceptable reliability. Most of the variance was attributable to differences in the cases. The analysis showed that, to achieve a generalizability coefficient of more than 0.8, at least four judges would have to score each case, each on one occasion, with the mean score used as a severity indicator. A reliable, valid method of scoring the severity of medication errors that did not require knowledge of patient outcomes was developed; at least four judges were required in order to achieve reliable scores, and reliability was not affected by the professions of the judges or the number of occasions on which the errors were scored.
一种无需了解患者预后情况就能对用药差错严重程度进行评分的方法被开发并进行了测试。来自英国四家医院的30名医疗保健专业人员根据潜在患者预后情况，对50例用药差错进行了0至10分的评分，其中0分代表无潜在影响的病例，10分代表会导致死亡的病例。文献中报道的16例有实际患者预后情况的差错病例被纳入这些病例中，以评估评分的有效性。其中10例差错被评分两次。差错病例的严重程度、评分的时机、评判者、每位评判者的职业以及这些因素之间的相互作用被视为评分中潜在的变异性来源。通过将概化理论应用于两个模型对数据进行分析：一个基于被评分两次的10个病例且忽略职业差异的影响，另一个基于所有50个病例且忽略评分时机的影响。计算了不同评判者数量和评分时机下的概化系数。概化系数达到0.8或更高被认为代表可接受的可靠性。大部分方差归因于病例之间的差异。分析表明，要使概化系数超过0.8，每个病例至少需要四名评判者各进行一次评分，并将平均分用作严重程度指标。开发了一种可靠、有效的对用药差错严重程度进行评分的方法，该方法无需了解患者预后情况；为了获得可靠的评分至少需要四名评判者，并且可靠性不受评判者职业或差错评分次数的影响。
