Department of Pediatrics, Johns Hopkins University, Baltimore, MD 21287, USA.
J Dev Behav Pediatr. 2010 Feb-Mar;31(2):129-36. doi: 10.1097/DBP.0b013e3181ce6509.
To describe inpatient and outpatient pediatric antidepressant medication errors.
We analyzed all error reports from the United States Pharmacopeia MEDMARX database, from 2003 to 2006, involving antidepressant medications and patients younger than 18 years.
Of the 451 error reports identified, 95% reached the patient, 6.4% reached the patient and necessitated increased monitoring and/or treatment, and 77% involved medications being used off label. Thirty-three percent of errors cited administering as the macrolevel cause of the error, 30% cited dispensing, 28% cited transcribing, and 7.9% cited prescribing. The most commonly cited medications were sertraline (20%), bupropion (19%), fluoxetine (15%), and trazodone (11%). We found no statistically significant association between medication and reported patient harm; harmful errors involved significantly more administering errors (59% vs 32%, p = .023), errors occurring in inpatient care (93% vs 68%, p = .012) and extra doses of medication (31% vs 10%, p = .025) compared with nonharmful errors. Outpatient errors involved significantly more dispensing errors (p < .001) and more errors due to inaccurate or omitted transcription (p < .001), compared with inpatient errors. Family notification of medication errors was reported in only 12% of errors.
Pediatric antidepressant errors often reach patients, frequently involve off-label use of medications, and occur with varying severity and type depending on location and type of medication prescribed. Education and research should be directed toward prompt medication error disclosure and targeted error reduction strategies for specific medication types and settings.
描述住院和门诊儿科抗抑郁药用药错误。
我们分析了美国药典 MEDMARX 数据库 2003 年至 2006 年期间涉及年龄小于 18 岁患者的所有抗抑郁药用药错误报告。
在确定的 451 份错误报告中，95%的错误涉及患者，6.4%的错误涉及患者且需要加强监测和/或治疗，77%的错误涉及药物超适应证使用。33%的错误将给药列为错误的宏观原因，30%的错误将配药列为错误原因，28%的错误将转录列为错误原因，7.9%的错误将处方列为错误原因。最常被引用的药物是舍曲林（20%）、安非他酮（19%）、氟西汀（15%）和曲唑酮（11%）。我们没有发现药物与报告的患者伤害之间存在统计学显著关联；有害错误涉及更多的给药错误（59%比 32%，p =.023）、更多发生在住院护理中的错误（93%比 68%，p =.012）和更多的额外剂量药物（31%比 10%，p =.025），与无害错误相比。与住院错误相比，门诊错误涉及更多的配药错误（p <.001）和更多因转录不准确或遗漏导致的错误（p <.001）。仅报告了 12%的错误中通知了患者家属药物错误。
儿科抗抑郁药错误经常涉及患者，经常涉及药物的超适应证使用，并且根据药物的使用地点和类型，其严重程度和类型有所不同。应针对及时披露药物错误和针对特定药物类型和使用环境的针对性错误减少策略进行教育和研究。
