Fontan Jean-Eudes, Maneglier Vincent, Nguyen Vu Xuan, Loirat Chantal, Brion Françoise
Pharmacie et Laboratoire de Toxico-pharmacologie, Hôpital Robert Debré AP-HP, 48 bd Sérurier 75019 Paris, France.
Pharm World Sci. 2003 Jun;25(3):112-7. doi: 10.1023/a:1024053514359.
The aim of this study was to evaluate the rates and types of drug prescription and administration errors in one pediatric nephrology ward, comparing two dispensing schemes: the first one defined as handwritten prescription plus ward stock distribution system (WSDS), and the second one as computerized prescription plus unit dose drug dispensing system (UDDDS).
Data were collected over an 8-week period, from 1 February to 31 March 1999. Two fifth-year pharmacy students photocopied prescription and administration documents on the ward each day, under the supervision of a senior pharmacist. The medical record analysis was used to compare the prescription with the administration report. Prescribing and administration medication errors were classified according to the American Society of Health-System Pharmacists.
Prescribing errors: overall, for both dispensing schemes, a total of 511 prescriptions, resulting in 4532 prescribed drugs (an average of 9 drugs per prescription) were prescribed. The total prescription error rate was 20.7% (937 of 4532), resulting in 1.9 errors per patient per day. The computerized prescription error rate was 10.6% (419 of 3943), the handwritten prescription error rate was 87.9% (518 of 589). This difference was very significant (P < 0.0001). ADMINISTRATION ERRORS: The total opportunity of administration errors was 4589 (sum of administered and omitted drugs). The total administration error rate was 23.5% (1077 of 4589) including wrong administration time, and 11.7% (538 of 4589) excluding administration time. The administration error rate, including administration associated with time errors, was only 22.5% (888 of 3943) for computerized prescription + UDDDS, compared with 29.3% (189 of 646) for handwritten prescriptions plus WSDS (P < 0.001). Excluding administration associated with time errors, the administration error rates were 9.7% and 24.3%, respectively (P < 0.0001).
The drug prescription and administration error rates were significantly decreased using computerized prescription plus UDDDS as compared with handwritten prescription plus WSDS in a pediatric unit (even with potential biases taken into account).
本研究旨在评估一家儿科肾病病房的药物处方和给药错误的发生率及类型，比较两种配药方案：第一种定义为手写处方加病房库存分发系统（WSDS），第二种为计算机化处方加单剂量药物配药系统（UDDDS）。
数据收集于1999年2月1日至3月31日的8周期间。两名五年级药学专业学生在一名资深药剂师的监督下，每天复印病房的处方和给药文件。通过病历分析将处方与给药报告进行比较。根据美国卫生系统药师协会的标准对处方和给药用药错误进行分类。
处方错误：总体而言，对于两种配药方案，共开出511张处方，涉及4532种处方药（平均每张处方9种药物）。总处方错误率为20.7%（4532种中有937种），即每位患者每天有1.9次错误。计算机化处方错误率为10.6%（3943种中有419种），手写处方错误率为87.9%（589种中有518种）。这种差异非常显著（P < 0.0001）。给药错误：给药错误的总机会为4589次（已给药和遗漏药物的总和）。总给药错误率为23.5%（4589次中有1077次），包括给药时间错误，不包括给药时间的错误率为11.7%（4589次中有538次）。对于计算机化处方 + UDDDS，包括与时间错误相关的给药错误率仅为22.5%（3943次中有888次），而手写处方加WSDS的错误率为29.3%（646次中有189次）（P < 0.001）。不包括与时间错误相关的给药，错误率分别为9.7%和24.3%（P < 0.0001）。
在儿科病房中，与手写处方加WSDS相比，使用计算机化处方加UDDDS可显著降低药物处方和给药错误率（即使考虑到潜在偏差）。
