Kane-Gill S L, Kowiatek J G, Weber R J
Center for Pharmacoinformatics and Outcomes Research, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA.
Qual Saf Health Care. 2010 Feb;19(1):55-9. doi: 10.1136/qshc.2008.027961.
Few institutions currently track intensive care unit (ICU)-specific medication safety data. A comparison of medication error data for intensive care and general care units may determine if ICU-specific surveillance is needed.
To compare the type, cause, contributing factors, level of staff initiating an error, medication use process node, drug classes and patient outcomes for voluntarily reported medication errors occurring in ICUs and general care units.
Retrospective evaluation of voluntarily reported medication errors over 4.5 years at a 647-bed academic medical centre containing greater than 120 ICU beds. Adult patients with a reported medication error in intensive care and general care units were included. Medication error data were compared for ICUs with general care units.
There were a total of 3252 medication errors reported with 541 and 2711 occurring in ICUs and general care units, respectively. Primary types of medication errors were prescribing in the ICUs and omission in the general care units. Leading causes of medication errors were procedure/protocol not followed and knowledge deficit in the ICU and general care units. More frequently there was no contributing factor identified for medication errors in the ICUs. The top three drugs associated with medication errors in the ICUs were opioid analgesics, beta-lactam antimicrobials and blood coagulation modifiers compared with anti-asthma/bronchodilators, narcotic analgesics and vaccines in the general care units. The level of care provided after the error was observation increased/initiated in ICUs and no additional care in general care units. Prolonged hospitalisation was a result of medication errors in 1% of ICU cases and 0.4% of general care unit errors (p = 0.056). Medication errors were associated with harm in 12% and 6% of cases in the ICUs and general care units, respectively (p<0.001).
Type, contributing factors, drug classes and patient outcomes associated with voluntarily reported medication errors differ in intensive care and general care units so it is important to develop surveillance systems that analyse ICU-specific data allowing systematic changes for this patient population.
目前很少有机构跟踪重症监护病房（ICU）特定的用药安全数据。比较重症监护病房和普通病房的用药错误数据可能有助于确定是否需要针对ICU进行特定监测。
比较ICU和普通病房中自愿报告的用药错误的类型、原因、促成因素、引发错误的工作人员级别、用药过程节点、药物类别及患者结局。
对一家拥有647张床位且ICU床位超过120张的学术医疗中心4.5年间自愿报告的用药错误进行回顾性评估。纳入在重症监护病房和普通病房报告有用药错误的成年患者。将ICU的用药错误数据与普通病房的数据进行比较。
共报告3252例用药错误，其中ICU发生541例，普通病房发生2711例。用药错误的主要类型在ICU是处方错误，在普通病房是漏用。用药错误的主要原因在ICU和普通病房都是未遵循程序/方案以及知识欠缺。ICU中用药错误更常未发现促成因素。与ICU用药错误相关的前三种药物是阿片类镇痛药、β-内酰胺类抗菌药物和血液凝固调节剂，而普通病房是抗哮喘/支气管扩张剂、麻醉性镇痛药和疫苗。错误发生后在ICU增加/开始观察护理，在普通病房则无额外护理。1%的ICU病例和0.4%的普通病房病例因用药错误导致住院时间延长（p = 0.056）。用药错误在ICU和普通病房分别导致12%和6%的病例出现伤害（p<0.001）。
ICU和普通病房中与自愿报告的用药错误相关的类型、促成因素、药物类别及患者结局有所不同，因此开发能够分析ICU特定数据的监测系统很重要，以便针对该患者群体进行系统性改进。
