Engum Scott A, Breckler Francine D
Division of Pediatric Surgery, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA.
J Pediatr Surg. 2008 Feb;43(2):348-52. doi: 10.1016/j.jpedsurg.2007.10.042.
Medication errors in pediatric patients are well recognized. The need for weight-adjusted dosing and changes in pharmacokinetic parameters make this patient population susceptible. Surgical literature discussing this topic is limited. The purpose of this study was to review the medication errors (variances) on surgical services at a major children's teaching hospital.
Medication variances occurring from January 2004 to June 2006 were reviewed. Data included service, physician, medication, type of variance, severity, explanation of variance, and time of occurrence.
There were 757 patients affected hospital-wide by a medication variance (n = 1340) for which 180 patients were on a surgical service (n = 308 variances). Residents accounted for 82% of all variances. Medication variances occurred most frequently on the general (36%) and neurosurgery services (20.5%). Seventy-one percent of the variances were classified as potential to cause harm but were corrected before reaching the patient. Five percent of variances reached the patient and caused temporary harm. Incorrect dose accounted for 72% of variances, followed by incorrect dosage form or omission in 5%, and missed allergies in 4%. Antibiotics were implicated in 31% of variances. Most errors occurred during daytime work hours.
Our data show that most of prescribing medication variances never reached the patient and were recognized by pharmacy or nursing. There is a continued need to enhance local education (resident) using a service-specific clinical pharmacist to focus on appropriate dosing especially in regard to antibiotics. Computerized physician order entry when implemented will help to minimize some of these errors. However, in the interim, a service-specific medication dosing card is being implemented. Quarterly service-specific data will be incorporated into the resident/fellow clinical conferences to minimize future variance occurrences.
儿科患者的用药错误已得到充分认识。由于需要根据体重调整剂量以及药代动力学参数的变化，使这一患者群体容易发生用药错误。讨论该主题的外科文献有限。本研究的目的是回顾一家大型儿童教学医院外科服务中的用药错误（差异）情况。
回顾了2004年1月至2006年6月期间发生的用药差异。数据包括服务科室、医生、药物、差异类型、严重程度、差异解释以及发生时间。
全院有757名患者受到用药差异影响（n = 1340），其中180名患者接受外科服务（n = 308个差异）。住院医师造成的差异占所有差异的82%。用药差异最常发生在普通外科（36%）和神经外科服务科室（20.5%）。71%的差异被归类为有潜在危害，但在到达患者之前得到了纠正。5%的差异影响到了患者并造成了暂时伤害。剂量错误占差异的72%，其次是剂型错误或遗漏占5%，漏查过敏占4%。31%的差异涉及抗生素。大多数错误发生在白天工作时间。
我们的数据表明，大多数处方用药差异从未影响到患者，并且被药房或护理人员发现。持续需要通过特定服务的临床药师加强对住院医师的局部教育，以关注适当的剂量，尤其是抗生素方面。实施计算机化医嘱录入将有助于减少其中一些错误。然而，在此期间，正在实施特定服务的用药剂量卡片。每季度特定服务的数据将纳入住院医师/专科住院医师临床会议，以尽量减少未来差异的发生。
