Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, UK.
Br J Clin Pharmacol. 2009 Jun;67(6):629-40. doi: 10.1111/j.1365-2125.2008.03330.x. Epub 2008 Oct 23.
Prescribing errors are an important cause of patient safety incidents, generally considered to be made more frequently by junior doctors, but prevalence and causality are unclear. In order to inform the design of an educational intervention, a systematic review of the literature on prescribing errors made by junior doctors was undertaken.
Searches were undertaken using the following databases: MEDLINE; EMBASE; Science and Social Sciences Citation Index; CINAHL; Health Management Information Consortium; PsychINFO; ISI Proceedings; The Proceedings of the British Pharmacological Society; Cochrane Library; National Research Register; Current Controlled Trials; and Index to Theses. Studies were selected if they reported prescribing errors committed by junior doctors in primary or secondary care, were in English, published since 1990 and undertaken in Western Europe, North America or Australasia.
Twenty-four studies meeting the inclusion criteria were identified. The range of error rates was 2-514 per 1000 items prescribed and 4.2-82% of patients or charts reviewed. Considerable variation was seen in design, methods, error definitions and error rates reported.
The review reveals a widespread problem that does not appear to be associated with different training models, healthcare systems or infrastructure. There was a range of designs, methods, error definitions and error rates, making meaningful conclusions difficult. No definitive study of prescribing errors has yet been conducted, and is urgently needed to provide reliable baseline data for interventions aimed at reducing errors. It is vital that future research is well constructed and generalizable using standard definitions and methods.
处方错误是导致患者安全事件的一个重要原因，通常认为这类错误更容易发生在初级医生身上，但目前尚不清楚其普遍性和因果关系。为了设计教育干预措施，我们对初级医生开具处方错误的相关文献进行了系统综述。
使用以下数据库进行检索：MEDLINE、EMBASE、科学和社会科学引文索引、CINAHL、健康管理信息联合会、心理信息、ISI 会议录、英国药理学会会议录、Cochrane 图书馆、国家研究登记册、当前对照试验和论文索引。符合纳入标准的研究包括初级保健或二级保健中初级医生开具处方错误的研究，以英语发表，且发表时间在 1990 年以后，研究地点在西欧、北美或澳大拉西亚。
共确定了 24 项符合纳入标准的研究。错误率范围为每千项医嘱 2-514 次，经审查的患者或医嘱比例为 4.2-82%。研究设计、方法、错误定义和错误率报告均存在较大差异。
综述结果显示，这是一个普遍存在的问题，且似乎与不同的培训模式、医疗体系或基础设施无关。研究设计、方法、错误定义和错误率报告各不相同，难以得出明确的结论。目前还没有针对开具处方错误的确定性研究，迫切需要为旨在减少错误的干预措施提供可靠的基线数据。未来的研究至关重要，必须采用标准的定义和方法进行精心设计和推广。
