Oshikoya K A, Ojo O I
Department of Pharmacology and Therapeutics, Lagos State University College of Medicine, Ikeja, Lagos.
Nig Q J Hosp Med. 2007 Apr-Jun;17(2):74-8. doi: 10.4314/nqjhm.v17i2.12547.
Proper and adequate pharmacovigilance is lacking in children's drug therapy, especially in developing countries. Therefore these children are at risk of developing adverse reactions to drugs as a result of medication errors. Having a better understanding of the types of error in a teaching hospital would be an important step toward quality improvement in children drug therapy.
This study was aimed at identifying the medication errors most frequently committed in the paediatric outpatient prescriptions at the Lagos State University Teaching Hospital, Ikeja and to suggest effective strategies for reducing these errors.
A total of 2,000 paediatric outpatient prescriptions randomly selected from five months prescriptions were studied. Information extracted from the prescription forms are age, sex and the drug prescription proper (adequacy of the dosage and duration of use; generic or trade name prescription; using abbreviation or acronym; prescribing injections in millilitres or milligram, syrup or suspensions in millilitres or milligram, tablets in unit numbers or milligram; and giving instructions on how to use the drugs in the case of drug-drug, drug-disease or drug-food interactions).
A total of 1944 prescriptions met the criteria for inclusion in the study. Antimalarials (89.9%), analgesics (66.4%), vitamin B complex (61.5%) and antibiotics (41.4%) were the most prescribed drugs. Errors identified are inadequate medication dosing duration; omission of age, dosage, and duration of drug use; improper dosaging and prescription of those drugs that could adversely interact. While paracetamol, 94.6% of the analgesics, was prescribed for an average of 3.2 +/- 0.6 days, antibiotics were prescribed for an average of 6.2 +/- 1.0 days. Duration of use was omitted in 24 (2.0%) and 12 (1.5%) prescriptions for paracetamol and antibiotics respectively. Errors of overdosaging and underdosaging were common to most of the commonly prescribed drugs. Underdosage and overdosage were associated with 2518 (38.0%) and 1247 (18.8%) drugs respectively. There was a significant difference in the dosage error made in the prescription of tablets in mg/kg and in unit number of tablets (/2 = 148.42) and in the prescription of syrups/suspensions in millilitre and in mg/kg (/2 = 95.58). Inadequate and omission of the duration of use of the drugs were observed in 1981(28.3%) and 61(0.9%) prescriptions respectively.
Children presenting to the LASUTH are at a greater risk of adverse drug reactions from overdosage prescriptions and are also facing the risk of treatment inadequacy and failure from underdosage prescriptions. Therefore a monitoring committee is urgently required to be put in place to review all paediatric prescriptions for appropriateness, adequacy and dosage accuracy using the patient's weight, age, and other appropriate indicator(s) before dispensing and/or refill for paediatric patients. Also rational drug prescription should form part of the monthly continuous medical education of the hospital with much focus on the paediatric doctors.
儿童药物治疗缺乏适当且充分的药物警戒，尤其是在发展中国家。因此，这些儿童因用药错误而面临药物不良反应的风险。更好地了解教学医院中的错误类型将是提高儿童药物治疗质量的重要一步。
本研究旨在确定伊凯贾拉各斯州立大学教学医院儿科门诊处方中最常出现的用药错误，并提出减少这些错误的有效策略。
从五个月的处方中随机抽取2000份儿科门诊处方进行研究。从处方表格中提取的信息包括年龄、性别以及药物处方本身（剂量和使用时长是否合适；通用名或商品名处方；使用缩写或首字母缩写；以毫升或毫克开具注射剂处方，以毫升或毫克开具糖浆或混悬剂处方，以单位数量或毫克开具片剂处方；以及在药物相互作用、药物与疾病相互作用或药物与食物相互作用的情况下给出用药说明）。
共有1944份处方符合纳入本研究的标准。抗疟药（89.9%）、镇痛药（66.4%）、复合维生素B（61.5%）和抗生素（41.4%）是最常开具的药物。识别出的错误包括用药剂量时长不足；遗漏年龄、剂量和药物使用时长；那些可能产生不良相互作用的药物剂量不当和处方不当。虽然94.6%的镇痛药对乙酰氨基酚平均开具3.2±0.6天，但抗生素平均开具6.2±1.0天。对乙酰氨基酚和抗生素的处方中分别有24份（2.0%）和12份（1.5%）遗漏了使用时长。大多数常用药物都存在用药过量和用药不足的错误。用药不足和用药过量分别与2518种（38.0%）和1247种（18.8%）药物相关。以毫克/千克开具片剂处方和以片剂单位数量开具处方（χ² = 148.42）以及以毫升开具糖浆/混悬剂处方和以毫克/千克开具处方（χ² = 95.58）时，剂量错误存在显著差异。分别在1981份（28.3%）和61份（0.9%）处方中观察到药物使用时长不足和遗漏的情况。
到拉各斯大学教学医院就诊的儿童因过量处方面临更大的药物不良反应风险，同时也面临因剂量不足处方导致治疗不充分和失败的风险。因此，迫切需要设立一个监测委员会，在为儿科患者配药和/或再次配药前，使用患者的体重、年龄和其他适当指标审查所有儿科处方的适宜性、充分性和剂量准确性。此外，合理用药处方应成为医院每月持续医学教育的一部分，尤其要重点关注儿科医生。
