Cimino Michael A, Kirschbaum Mark S, Brodsky Linda, Shaha Steven H
Children's Hospital of Buffalo/Kaleida Health, Buffalo, NY, USA.
Pediatr Crit Care Med. 2004 Mar;5(2):124-32. doi: 10.1097/01.PCC.0000112371.26138.E8.
To evaluate a matrix for determining the predominant type, cause category, and rate of medication prescribing errors, and to explore the effectiveness of hospital-based improvement initiatives among pediatric intensive care units (PICUs).
This study involved the prospective identification of medication errors for categorization and evaluation by using a matrix methodology. A pretest-posttest design without a control group was used to explore the impact of initiatives employed to reduce medication error rates and severity.
PICUs in nine freestanding, collaborating tertiary care children's hospitals that participated in both baseline and postintervention analyses.
We evaluated 12,026 PICU medication orders at baseline and 9,187 orders postintervention for prescribing errors, excluding resuscitation orders. A standardized tool and process captured error type, cause category, and severity for 2 wks before and after intervention. Three levels of error detection were used and included pharmacy order entry, PICU nurse order transcription, and team-based overview. Site-specific interventions were implemented, which included predominantly provider education as well as informational (47%) and dosing "assists" via preprinted orders, forcing functions, or prompts (39%).
Of baseline orders, 11.1% had at least one prescribing error. The interception of prescribing errors improved 30.9% (1.6% of all orders at baseline, 2.0% post intervention). Preventable adverse drug events were uncommon (0.6% of all medication errors) and of low severity at baseline; most were wrong dose errors. The implementation of improvement initiatives, specific for each facility, resulted in a 31.6% reduction in prescribing errors from 11.1% to 7.6%. However, site results varied considerably.
A benchmark for medication prescribing errors in the PICU was identified among nine children's hospitals. The methodology was successful in accounting for site-specific differences with regard to identifying and documenting errors as well as reporting results of improvement initiatives. Furthermore, the methodology employed was generalizable in the identification of predominant prescribing error types, which helped to track individual hospital improvement initiative development and implementation. Overall improvement in prescribing error rates was noted; however, considerable variation in the success of improvement initiatives was noted and bears further attention.
评估一种用于确定用药处方错误的主要类型、原因类别和发生率的矩阵，并探讨儿科重症监护病房（PICUs）中基于医院的改进措施的有效性。
本研究采用矩阵方法对用药错误进行前瞻性识别、分类和评估。采用无对照组的前后测试设计，以探讨为降低用药错误率和严重程度而采取的措施的影响。
9家独立的、合作的三级护理儿童医院的儿科重症监护病房，参与了基线和干预后分析。
我们评估了基线时的12026份儿科重症监护病房用药医嘱和干预后的9187份医嘱，以查找处方错误，不包括复苏医嘱。一个标准化工具和流程记录了干预前后2周内的错误类型、原因类别和严重程度。采用了三个错误检测级别，包括药房医嘱录入、儿科重症监护病房护士医嘱转录和基于团队的概述。实施了针对特定地点的干预措施，主要包括对医护人员的教育以及通过预印医嘱、强制功能或提示进行信息（47%）和剂量“协助”（39%）。
在基线医嘱中，11.1%至少有一处处方错误。处方错误的拦截率提高了30.9%（基线时占所有医嘱的1.6%，干预后为2.0%）。可预防的药物不良事件并不常见（占所有用药错误的0.6%），且在基线时严重程度较低；大多数是剂量错误。针对每个机构实施的改进措施使处方错误率从11.1%降至7.6%，降低了31.6%。然而，各机构的结果差异很大。
在9家儿童医院中确定了儿科重症监护病房用药处方错误的基准。该方法在识别和记录错误以及报告改进措施结果方面成功地考虑了特定地点的差异。此外，所采用的方法在识别主要处方错误类型方面具有通用性，这有助于跟踪各医院改进措施的制定和实施。总体而言，处方错误率有所改善；然而，注意到改进措施的成功存在相当大的差异，值得进一步关注。
