Rinke Michael L, Shore Andrew D, Morlock Laura, Hicks Rodney W, Miller Marlene R
Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Cancer. 2007 Jul 1;110(1):186-95. doi: 10.1002/cncr.22742.
Little is known regarding chemotherapy medication errors in pediatrics despite studies suggesting high rates of overall pediatric medication errors. In this study, the authors examined patterns in pediatric chemotherapy errors.
The authors queried the United States Pharmacopeia MEDMARX database, a national, voluntary, Internet-accessible error reporting system, for all error reports from 1999 through 2004 that involved chemotherapy medications and patients aged <18 years.
Of the 310 pediatric chemotherapy error reports, 85% reached the patient, and 15.6% required additional patient monitoring or therapeutic intervention. Forty-eight percent of errors originated in the administering phase of medication delivery, and 30% originated in the drug-dispensing phase. Of the 387 medications cited, 39.5% were antimetabolites, 14.0% were alkylating agents, 9.3% were anthracyclines, and 9.3% were topoisomerase inhibitors. The most commonly involved chemotherapeutic agents were methotrexate (15.3%), cytarabine (12.1%), and etoposide (8.3%). The most common error types were improper dose/quantity (22.9% of 327 cited error types), wrong time (22.6%), omission error (14.1%), and wrong administration technique/wrong route (12.2%). The most common error causes were performance deficit (41.3% of 547 cited error causes), equipment and medication delivery devices (12.4%), communication (8.8%), knowledge deficit (6.8%), and written order errors (5.5%). Four of the 5 most serious errors occurred at community hospitals.
Pediatric chemotherapy errors often reached the patient, potentially were harmful, and differed in quality between outpatient and inpatient areas. This study indicated which chemotherapeutic agents most often were involved in errors and that administering errors were common. Investigation is needed regarding targeted medication administration safeguards for these high-risk medications.
尽管研究表明儿科用药错误总体发生率较高，但关于儿科化疗用药错误的情况却知之甚少。在本研究中，作者调查了儿科化疗错误的模式。
作者查询了美国药典MEDMARX数据库，这是一个全国性的、自愿参与的、可通过互联网访问的错误报告系统，获取了1999年至2004年期间所有涉及化疗药物和18岁以下患者的错误报告。
在310份儿科化疗错误报告中，85%的错误影响到了患者，15.6%的错误需要对患者进行额外监测或治疗干预。48%的错误发生在给药阶段，30%的错误发生在药物调配阶段。在387种被提及的药物中，39.5%是抗代谢药，14.0%是烷化剂，9.3%是蒽环类药物，9.3%是拓扑异构酶抑制剂。最常涉及的化疗药物是甲氨蝶呤（15.3%）、阿糖胞苷（12.1%）和依托泊苷（8.3%）。最常见的错误类型是剂量/数量不当（在327种被提及的错误类型中占22.9%）、时间错误（22.6%）、遗漏错误（14.1%）以及给药技术/途径错误（12.2%）。最常见的错误原因是操作失误（在547种被提及的错误原因中占41.3%）、设备和给药装置问题（12.4%）、沟通问题（8.8%）、知识欠缺（6.8%）以及书面医嘱错误（5.5%）。5个最严重的错误中有4个发生在社区医院。
儿科化疗错误常常影响到患者，可能具有危害性，且门诊和住院区域的错误性质有所不同。本研究指出了哪些化疗药物最常涉及错误，以及给药错误很常见。需要针对这些高风险药物的靶向给药保障措施展开调查。
