Coombes I D, Stowasser D A, Reid C, Mitchell C A
Safe Medication Practice Unit, Royal Brisbane and Women's Hospital, Level 13, Block 7, Herston Rd, Brisbane, QLD 4006, Australia.
Qual Saf Health Care. 2009 Dec;18(6):478-85. doi: 10.1136/qshc.2007.025296.
(1) To develop and implement a standard medication chart, for recording prescribing (medication orders) and administration of medication in public hospitals in Queensland. (2) To assess the chart's impact on the frequency and type of prescribing errors, adverse drug reaction (ADR) documentation and safety of warfarin prescribing. (3) To use the chart to facilitate safe medication management training.
DESIGN, SETTING AND PARTICIPANTS: The medication chart was developed through a process of incident analysis and work practice mapping by a multidisciplinary collaborative. Observational audits by nurse and pharmacist pairs, of all available prescriptions before and after introduction of the standard medication chart, were undertaken in five sites.
Similar numbers of both patients (730 pre-implementation and 751 post-implementation; orders, 9772 before and 10 352 after) were observed. The prescribing error rate decreased from 20.0% of orders per patient before to 15.8% after (Mann-Whitney U test, p = 0.03). Previous ADRs were not documented for 19.5% of 185 patients before and 11.2% of 197 patients after (chi(2), p = 0.032). Prescribing errors involving selection of a drug to which a patient had had a previous ADR decreased from 11.3% of patients before to 4.6% after (chi(2), p = 0.021). International normalised ratios (INRs) >5 decreased from 1.9% of 14 405 INRs in the 12 months before to 1.45% of 15 090 INRs after (chi(2), p = 0.004). After minor modifications, the chart was introduced into all hospitals statewide, which enabled standardised medication training and safer rotation of staff. The chart also formed the basis for the National Inpatient Medication Chart.
Introduction of a standard revised medication chart significantly reduced the frequency of prescribing errors, improved ADR documentation and decreased the potential risks associated with warfarin management. The standard chart has enabled uniform training in medicine management.
（1）制定并实施一份标准用药图表，用于记录昆士兰州公立医院的处方开具（用药医嘱）及用药情况。（2）评估该图表对处方错误的频率和类型、药物不良反应（ADR）记录以及华法林处方安全性的影响。（3）使用该图表促进安全用药管理培训。
设计、地点和参与者：通过多学科协作进行事件分析和工作流程映射的过程制定了用药图表。护士和药剂师对在五个地点对标准用药图表引入前后所有可用处方进行了观察性审核。
观察到的患者数量相似（实施前730例，实施后751例；医嘱数量，实施前9772条，实施后10352条）。处方错误率从每位患者医嘱的20.0%降至实施后的15.8%（曼 - 惠特尼U检验，p = 0.03）。在185例患者中，之前有19.5%的患者未记录ADR，实施后在197例患者中这一比例为11.2%（卡方检验，p = 0.032）。涉及选择患者曾有ADR的药物的处方错误从之前患者的11.3%降至实施后的4.6%（卡方检验，p = 0.021）。国际标准化比值（INR）>5的情况从实施前12个月14405个INR中的1.9%降至实施后15090个INR中的1.45%（卡方检验，p = 0.004）。经过微小修改后，该图表在全州所有医院推行，这使得用药培训标准化且工作人员轮岗更安全。该图表还构成了国家住院患者用药图表的基础。
引入标准修订用药图表显著降低了处方错误的频率，改善了ADR记录，并降低了与华法林管理相关的潜在风险。该标准图表实现了用药管理的统一培训。
