Wong E, Taylor Z, Thompson J, Tuthill D
Cardiff University, Cardiff, UK.
Arch Dis Child. 2009 Jul;94(7):542-5. doi: 10.1136/adc.2007.137026. Epub 2008 Aug 1.
At least 5% of paediatric admissions are complicated by medication error. Nurses can prevent some errors by correctly verifying prescriptions before administering drugs, which requires adequate drug calculation skills and familiarity with the BNFc. We wished to explore whether a newly devised chart would improve nurses' dose calculation ability and thus potentially reduce doctors' prescription errors.
To explore nurses' ability to calculate doses of gentamicin for neonates and children using a new simple dosing chart compared with the BNFc.
Two gentamicin dosing charts (paediatric and neonatal) devised by a multidisciplinary group to simplify dose calculation and selection of frequency were compared with the BNFc using four questions (two neonatal, two paediatric) asking ward nurses to calculate gentamicin doses. Answers were scored for both the correct dosage and correct frequency.
51 nurses participated. 11 nurses (22%) answered all four questions correctly. A higher proportion correctly answered both the dosage and frequency questions simultaneously when using the chart compared with the BNFc: paediatric questions 100% (51/51 chart) versus 80% (41/51 BNFc) (OR 0.20) and neonatal questions 55% (28/51 chart) versus 35% (18/51 BNFc) (OR 0.2). Errors when using the BNFc were due to selection of the incorrect regimen (23%), wrong frequency (17%) and one 10-fold dosing error. When using the chart, there were no dosing errors, only frequency errors for the neonatal regimen.
The chart was more reliable, quicker and may be useful for patient safety. Revising the format of the BNFc may be beneficial for nurses.
至少5%的儿科住院病例因用药错误而变得复杂。护士可以通过在给药前正确核对处方来预防一些错误，这需要足够的药物计算技能和对《英国国家处方集儿童版》（BNFc）的熟悉程度。我们希望探讨一种新设计的图表是否能提高护士的剂量计算能力，从而有可能减少医生的处方错误。
与《英国国家处方集儿童版》（BNFc）相比，探讨护士使用一种新的简单给药图表计算新生儿和儿童庆大霉素剂量的能力。
由一个多学科团队设计的两张庆大霉素给药图表（儿科和新生儿），用于简化剂量计算和给药频率选择，与《英国国家处方集儿童版》（BNFc）进行比较，通过四个问题（两个新生儿问题，两个儿科问题）让病房护士计算庆大霉素剂量。对答案的正确剂量和正确频率进行评分。
51名护士参与。11名护士（22%）正确回答了所有四个问题。与使用《英国国家处方集儿童版》（BNFc）相比，使用图表时同时正确回答剂量和频率问题的比例更高：儿科问题100%（51/51使用图表）对80%（41/51使用BNFc）（比值比0.20），新生儿问题55%（28/51使用图表）对35%（18/51使用BNFc）（比值比0.2）。使用《英国国家处方集儿童版》（BNFc）时的错误是由于选择了不正确的治疗方案（23%）、错误的频率（17%）和一个10倍的给药错误。使用图表时，没有给药错误，只有新生儿治疗方案的频率错误。
该图表更可靠、更快，可能对患者安全有用。修订《英国国家处方集儿童版》（BNFc）的格式可能对护士有益。
