Prot Sonia, Fontan Jean Eudes, Alberti Corinne, Bourdon Olivier, Farnoux Caroline, Macher Marie Alice, Foureau Anita, Faye Albert, Beaufils François, Gottot Serge, Brion Françoise
Pharmacy Unit, Hôpital Robert Debré AP-HP, Paris, France.
Int J Qual Health Care. 2005 Oct;17(5):381-9. doi: 10.1093/intqhc/mzi066. Epub 2005 Aug 22.
. To quantify the type and frequency of drug administration errors to pediatric in-patients and to identify associated factors.
Prospective direct-observation study of drug administration errors from April 2002 to March 2003.
Four clinical units in a pediatric teaching hospital.
Twelve observers accompanied nurses giving medications and witnessed the preparation and administration of all drugs to all patients on all weekday mornings.
None.
Discrepancies between physicians' orders and actual drug administration.
During the 1719 observed administrations to 336 patients by 485 nurses, 538 administration errors were detected, involving timing (36%), route (19%), dosage (15%), unordered drug (10%), or form (8% form). These errors occurred for 467 (27%) of the 1719 administrations. Intravenous drugs (OR = 0.28; CI = 0.16-0.49; versus miscellaneous) were associated with fewer errors. Error rates were higher for cardiovascular (OR = 3.38; CI = 1.24-9.27; versus miscellaneous) and central nervous system drugs (OR = 2.65; CI = 1.06-6.59; versus miscellaneous); unspecified dispensing system (OR = 2.06; CI = 1.29-3.29; versus store in the unit); non-intravenous non-oral administration (OR = 4.44; CI = 1.81-10.88; versus oral administration); preparation by the pharmacy (OR = 1.66; CI = 1.10-2.51); and administration by a hospital pool nurse, temporary staffing agency nurse, or nurse intern (OR = 1.67; CI = 1.04-2.68; versus registered full-time nurse). Each additional management procedure in the patient increased the risk of error (OR = 1.22; CI = 1.01-1.48).
The risk factors identified in our study should prove useful for designing preventive strategies, thereby improving the quality of care.
量化儿科住院患者用药错误的类型和频率，并确定相关因素。
2002年4月至2003年3月对用药错误进行的前瞻性直接观察研究。
一家儿科教学医院的四个临床科室。
12名观察员在护士给药时陪同，见证了所有工作日上午所有患者所有药物的配制和给药过程。
无。
医生医嘱与实际用药之间的差异。
在485名护士对336名患者进行的1719次观察给药中，检测到538次给药错误，涉及时间（36%）、途径（19%）、剂量（15%）、未医嘱用药（10%）或剂型（8%）。这些错误发生在1719次给药中的467次（27%）。静脉用药（比值比=0.28；可信区间=0.16 - 0.49；与其他药物相比）错误较少。心血管药物（比值比=3.38；可信区间=1.24 - 9.27；与其他药物相比）和中枢神经系统药物（比值比=2.65；可信区间=1.06 - 6.59；与其他药物相比）的错误率较高；未指定的配药系统（比值比=2.06；可信区间=1.29 - 3.29；与科室储存相比）；非静脉非口服给药（比值比=4.44；可信区间=1.81 - 10.88；与口服给药相比）；药房配制（比值比=1.66；可信区间=1.10 - 2.51）；以及由医院集中调配护士、临时人员派遣机构护士或实习护士给药（比值比=1.67；可信区间=1.04 - 2.68；与注册全职护士相比）。患者每增加一项管理程序，错误风险就增加（比值比=1.22；可信区间=1.01 - 1.48）。
我们研究中确定的风险因素应有助于设计预防策略，从而提高护理质量。
