Chang Yun-Kyung, Mark Barbara A
School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
J Nurs Scholarsh. 2009 Mar;41(1):70-8. doi: 10.1111/j.1547-5069.2009.01253.x.
To investigate if differences in antecedents of severe and nonsevere medication errors exist.
A longitudinal study of 6 months of data from 279 nursing units in 146 randomly selected hospitals in the United States (US).
Antecedents of severe and nonsevere medication errors included work environment factors (work dynamics and RN hours), team factors (communication with physicians and nurses' expertise), person factors (nurses' education and experience), patient factors (age, health status, and previous hospitalization), and medication-related support services. Generalized estimating equations with a negative binomial distribution were used with nursing units as the unit of analysis.
None of the antecedents allowed predicting both types of medication errors. Nurses' expertise had a negative and medication-related support services had a positive association with nonsevere medication errors. Nurses' educational level had a significant nonlinear relationship with severe medication errors only: As the percentage of unit BSN-prepared nurses increased, severe medication errors decreased until the percentage of BSN-prepared nurses reached 54%. In contrast, RN experience had a statistically significant relationship with nonsevere medication errors only and nursing units with more experienced nurses reported more nonsevere medication errors.
Severe and nonsevere medication errors might have different antecedents.
Error prevention and management strategies should be targeted to specific types of medication errors for best results.
调查严重和非严重用药错误的前置因素是否存在差异。
一项对美国146家随机选取医院的279个护理单元进行的为期6个月的数据纵向研究。
严重和非严重用药错误的前置因素包括工作环境因素（工作动态和注册护士工作时长）、团队因素（与医生的沟通和护士的专业技能）、个人因素（护士的教育程度和经验）、患者因素（年龄、健康状况和既往住院史）以及与用药相关的支持服务。以护理单元为分析单位，使用具有负二项分布的广义估计方程。
没有任何前置因素能够同时预测这两种类型的用药错误。护士的专业技能与非严重用药错误呈负相关，与用药相关的支持服务与非严重用药错误呈正相关。护士的教育水平仅与严重用药错误存在显著的非线性关系：随着护理单元中拥有护理学学士（BSN）学位护士的比例增加，严重用药错误减少，直到拥有BSN学位护士的比例达到54%。相比之下，注册护士的经验仅与非严重用药错误存在统计学上的显著关系，护士经验更丰富的护理单元报告的非严重用药错误更多。
严重和非严重用药错误可能有不同的前置因素。
为了取得最佳效果，错误预防和管理策略应针对特定类型的用药错误。
