von Laue Nicoletta C, Schwappach David L B, Koeck Christian M
Department of Health Policy and Management, University Witten/Herdecke, Witten, Germany.
Wien Klin Wochenschr. 2003 Jul 15;115(12):407-15. doi: 10.1007/BF03040432.
A growing amount of data suggests that adverse drug events (ADEs) in hospital settings are frequent and result in substantial harm. Even though prevention is where efforts must be directed, only a few studies have reported on the preventability of these events. The objective of this article is to review the literature of ADEs and their preventability, and to report on their incidences, characteristics, risk factors, costs and prevention strategies.
We systematically searched Medline and Embase for literature published between 1980 and June 2002. All articles reporting primary data on the incidences of ADEs and their preventability in hospital settings were included.
In the 8 articles retrieved the incidences of ADEs were between 0.7% and 6.5% of hospitalized patients; in up to 56.6% these events were judged to be preventable. Furthermore, ADEs accounted for 2.4% to 4.1% of admissions to inpatient facilities; preventability was stated in up to 69.0% of these events. A substantial body of preventable ADEs, the so-called medication errors, occur in the process of ordering, transcribing, dispensing and administrating the drugs. Further investigations into medication errors at the ordering stage reveal their occurrence in up to 57.0 per 1,000 orders. Between 18.7% and 57.7% of those errors have the potential for harm, but only in about 1% they result in preventable ADEs.
The detection of errors having only the potential for harm by means of computerized surveillance has shown to be a useful technique in order to understand and prevent ADEs. Apart from the use of sophisticated computer techniques the participation of pharmacists in the drug prescribing process results in a tremendous error reduction. The greatest task in changing the health care system into a system with safety as its first priority is to create a culture of constant learning from mistakes among health care professionals. The appreciation of the health care teams' ideas and perceptions for improvement, and their implementation through small improvement cycles, may represent the leading strength in error reduction and health care improvement.
越来越多的数据表明，医院环境中的药物不良事件（ADEs）很常见，并会造成严重危害。尽管预防是必须努力的方向，但只有少数研究报告了这些事件的可预防性。本文的目的是回顾药物不良事件及其可预防性的文献，并报告其发生率、特征、风险因素、成本和预防策略。
我们系统地检索了1980年至2002年6月期间发表在Medline和Embase上的文献。纳入所有报告医院环境中药物不良事件发生率及其可预防性的原始数据的文章。
在检索到的8篇文章中，药物不良事件的发生率在住院患者的0.7%至6.5%之间；其中高达56.6%的事件被判定为可预防。此外，药物不良事件占住院设施入院人数的2.4%至4.1%；其中高达69.0%的事件说明了可预防性。大量可预防的药物不良事件，即所谓的用药错误，发生在药物的医嘱开具、转录、调配和给药过程中。对医嘱开具阶段用药错误的进一步调查显示，其发生率高达每1000条医嘱57.0次。这些错误中有18.7%至57.7%有可能造成伤害，但只有约1%会导致可预防的药物不良事件。
通过计算机化监测发现仅具有潜在危害的错误已被证明是一种了解和预防药物不良事件的有用技术。除了使用先进的计算机技术外，药剂师参与药物处方过程可大幅减少错误。将医疗保健系统转变为以安全为首要优先事项的系统的最大任务是营造一种医疗保健专业人员不断从错误中学习的文化。重视医疗保健团队关于改进的想法和看法，并通过小的改进周期加以实施，可能是减少错误和改善医疗保健的主要力量。
