Franke Hillary A, Woods Donna M, Holl Jane L
Department of Pediatrics, Pediatric Critical Care Medicine, University of Arizona Health Sciences Center, USA.
Pediatr Crit Care Med. 2009 Jan;10(1):85-90. doi: 10.1097/PCC.0b013e3181936ff8.
To identify pediatric intensive care unit (PICU) clinicians' perceptions of high-alert medications and to develop a PICU-specific, high-alert medications list. We hypothesize that a PICU-specific list will include medications not identified on the Institute for Safe Medications Practices list and that the high-alert medications identified will differ by PICU clinician type (physicians, nurses, pharmacists).
PICU-specific multisite, institution-based survey of clinicians' perceptions of high-alert medications.
The PICU in each of five institutions participating in the Chicago Pediatric Patient Safety Consortium.
Nurses, physicians, and pharmacists working in the PICU.
None.
PICU clinicians identified their top ten high-alert medications and their perceptions of each medication's risks and frequency of misuse. Weighted responses were calculated and compared to the Institute for Safe Medications Practices list and by clinician type. Results are based on 112 surveys collected from 56 nurses (response rate: 29%), 26 physicians (79%), and 30 pharmacists (71%), with 90 different medications or medication classes named. The top high-alert medications identified included intravenous potassium (weighted response: 72%), heparin (63%), and insulin (48%). PICU-specific high-alert medications (e.g., calcium [27%], phenytoin [21%], aminoglycosides [15%]) were not reported on the Institute for Safe Medications Practices list. Nurses more often cited medications with administration error risk (e.g., adenosine, calcium, p < 0.01), while physicians reported those with narrow therapeutic windows (e.g., aminoglycosides, diuretics, p < 0.01), and pharmacists identified medications with both administration and narrow therapeutic window risks (e.g., insulin, digoxin, p < 0.01). Clinicians perceived the frequency of risk of misuse of the most common high-alert medications to be at least once a year.
PICU clinicians identified high-alert medications not identified on the Institute for Safe Medications Practices list. Risks of the identified high-alert medications were attributed to a wide range of different stages in the medication process as well as clinicians' varying experiences in the medication process.
确定儿科重症监护病房（PICU）临床医生对高警示药品的认知，并制定一份PICU专用的高警示药品清单。我们假设一份PICU专用清单将包括安全用药实践研究所清单中未列出的药品，并且所确定的高警示药品会因PICU临床医生类型（医生、护士、药剂师）的不同而有所差异。
针对临床医生对高警示药品认知的PICU专用多中心、基于机构的调查。
参与芝加哥儿科患者安全联盟的五家机构中的每家机构的PICU。
在PICU工作的护士、医生和药剂师。
无。
PICU临床医生列出了他们认为的十大高警示药品以及他们对每种药品风险和误用频率的认知。计算加权回复，并与安全用药实践研究所清单进行比较，同时按临床医生类型进行比较。结果基于从56名护士（回复率：29%）、26名医生（79%）和30名药剂师（71%）收集的112份调查问卷，共提及90种不同的药品或药品类别。所确定的首要高警示药品包括静脉用钾（加权回复：72%）、肝素（63%）和胰岛素（48%）。PICU专用的高警示药品（如钙[27%]、苯妥英[21%]、氨基糖苷类[15%]）未在安全用药实践研究所清单中报告。护士更常提及有用药错误风险的药品（如腺苷、钙，p<0.01），而医生报告的是治疗窗窄的药品（如氨基糖苷类、利尿剂，p<0.01），药剂师则确定了既有用药又有治疗窗窄风险的药品（如胰岛素、地高辛，p<0.01）。临床医生认为最常见的高警示药品的误用风险频率至少为每年一次。
PICU临床医生确定了安全用药实践研究所清单中未列出的高警示药品。所确定的高警示药品的风险归因于用药过程中的广泛不同阶段以及临床医生在用药过程中的不同经历。
