Advocate Christ Medical Center, Department of Emergency Medicine, Oak Lawn, IL 60453, USA.
Am J Emerg Med. 2010 Mar;28(3):304-9. doi: 10.1016/j.ajem.2008.12.014.
Despite the growing problems of emergency department (ED) crowding, the potential impact on the frequency of medication errors occurring in the ED is uncertain. Using a metric to measure ED crowding in real time (the Emergency Department Work Index, or EDWIN, score), we sought to prospectively measure the correlation between the degree of crowding and the frequency of medication errors occurring in our ED as detected by our ED pharmacists.
We performed a prospective, observational study in a large, community hospital ED of all patients whose medication orders were evaluated by our ED pharmacists for a 3-month period. Our ED pharmacists review the orders of all patients in the ED critical care section and the Chest Pain unit, and all admitted patients boarding in the ED. We measured the Spearman correlation between average daily EDWIN score and number of medication errors detected and determined the score's predictive performance with receiver operating characteristic (ROC) curves.
A total of 283 medication errors were identified by the ED pharmacists over the study period. Errors included giving medications at incorrect doses, frequencies, durations, or routes and giving contraindicated medications. Error frequency showed a positive correlation with daily average EDWIN score (Spearman's rho = 0.33; P = .001). The area under the ROC curve was 0.67 (95% confidence interval, 0.56-0.78) with failure defined as greater than 1 medication error per day.
We identified an increased frequency of medication errors in our ED with increased crowding as measured with a real-time modified EDWIN score.
尽管急诊科（ED）拥挤问题日益严重，但它对 ED 中发生药物错误的频率的潜在影响尚不确定。我们使用一种实时衡量 ED 拥挤程度的指标（急诊科工作指数，即 EDWIN 评分），前瞻性地衡量 ED 拥挤程度与我们的 ED 药剂师发现的药物错误频率之间的相关性。
我们对一家大型社区医院 ED 进行了前瞻性、观察性研究，研究对象为在 3 个月内接受 ED 药剂师评估的所有患者的医嘱。我们的 ED 药剂师审查 ED 危重病区和胸痛单元以及 ED 内住院的所有患者的医嘱。我们测量了平均每日 EDWIN 评分与检测到的药物错误数量之间的 Spearman 相关系数，并通过接收者操作特征（ROC）曲线确定了该评分的预测性能。
在研究期间，ED 药剂师共发现 283 例药物错误。错误包括给予错误剂量、频率、持续时间或途径的药物和给予禁忌药物。错误频率与每日平均 EDWIN 评分呈正相关（Spearman's rho = 0.33；P =.001）。ROC 曲线下面积为 0.67（95%置信区间，0.56-0.78），失败定义为每天大于 1 次药物错误。
我们发现，使用实时修改后的 EDWIN 评分衡量时，ED 拥挤程度增加与药物错误频率增加之间存在相关性。
