Vilke Gary M, Tornabene Stephen V, Stepanski Barbara, Shipp Holly E, Ray Leslie Upledger, Metz Marcelyn A, Vroman Dori, Anderson Marilyn, Murrin Patricia A, Davis Daniel P, Harley Jim
San Diego County Division of Emergency Medical Services, San Diego, CA, USA.
Prehosp Emerg Care. 2006 Oct-Dec;10(4):457-62. doi: 10.1080/10903120600885100.
Continuing quality improvement (CQI) reviews reflect that medication administration errors occur in the prehospital setting. These include errors involving dose, medication, route, concentration, and treatment.
A survey was given to paramedics in San Diego County. The survey tool was established based on previous literature reviews and questions developed based on previous CQI data.
A total of 352 surveys were returned, with the paramedics reporting a mean of 8.5 years of field experience. They work an average of 11.0 shifts/month with an average shift length of 25.4 hours and 6.7 calls/shift. Thirty-two responding paramedics (9.1%) reported committing a medication error in the past 12 months. Types of errors included dose-related errors (63%), protocol errors (33%), wrong route errors (21%), and wrong medication errors (4%). Issues identified in contributing to the errors include failure to triple check, infrequent use of the medication, dosage calculation error, and incorrect dosage given. Fatigue, training, and equipment setup of the drug box were not listed as any of the contributing factors. The majority of these errors were self-reported to their CQI representative (79.1%), with 8.3% reported by the base hospital radio nurse, 8.3% found on chart review, and 4.2% noted by the paramedic during the call but never reported.
Nine percent of paramedics responding to an anonymous survey reported medication errors in the past 12 months, with 4% of these errors never having been reported in the CQI process. Additional safeguards must continue to be implemented to decrease the incidence of medication errors.
持续质量改进（CQI）评估显示，院前环境中会发生用药错误。这些错误包括涉及剂量、药物、给药途径、浓度和治疗方面的错误。
对圣地亚哥县的护理人员进行了一项调查。该调查工具是根据以往的文献综述以及基于以往CQI数据提出的问题建立的。
共收回352份调查问卷，护理人员报告的现场工作经验平均为8.5年。他们平均每月工作11.0个班次，平均每班时长25.4小时，每班出诊6.7次。32名回复的护理人员（9.1%）报告在过去12个月中犯过用药错误。错误类型包括剂量相关错误（63%）、方案错误（33%）、给药途径错误（21%）和用药错误（4%）。导致这些错误的因素包括未进行三次核对、药物使用不频繁、剂量计算错误以及给药剂量不正确。疲劳、培训和药箱设备设置未被列为任何促成因素。这些错误中的大多数是护理人员自行向其CQI代表报告的（79.1%），8.3%由基地医院无线电护士报告，8.3%是在病历审查中发现的，4.2%是护理人员在出诊时注意到但从未报告过的。
在参与匿名调查的护理人员中，9%报告在过去12个月中出现过用药错误，其中4%的错误在CQI过程中从未被报告过。必须继续实施额外的保障措施以降低用药错误的发生率。
