Emergency Department and The Clinical Pharmacology and Toxicology Unit, Assaf Harofeh Medical Center, Zerifin, Israel.
Am J Emerg Med. 2012 Jun;30(5):726-31. doi: 10.1016/j.ajem.2011.04.023. Epub 2011 Jul 8.
Medication errors are a common cause of iatrogenic adverse drug events. The incidence and nature of medication errors during prehospital treatment have not been fully described.
The objectives of this study are to describe the incidence and characteristics of medication errors in adults during prehospital emergency treatment and in the emergency department (ED) and to identify risk factors for medication errors in those settings.
This is a retrospective study of adult patients transferred by emergency medical services to the ED of a university-affiliated hospital in Israel. The drugs administered in the mobile intensive care unit and in the ED were reviewed by 2 reviewers, who independently decided whether an error had occurred. The primary outcome was the number of drug errors per patient. Secondary outcomes were the type and severity of the errors and variables associated with increased incidence of drug errors.
During the study period, 1837 patients were brought to the ED by mobile intensive care unit vehicles. Five hundred thirty-six patient charts (29%) were randomly selected for review; 65 charts (12.12%) could not be found; thus, 471 charts were reviewed. In the emergency vehicle, 188 patients (45.63%) received medications; of those, 12.76% (24 patients) were subject to a medication error. The number of drugs administered and long evacuation times were associated with higher risk for an error (P<.01 and P=.011, respectively). The presence of a physician in the emergency vehicle did not alter the risk of an error (P=.95). In the ED, 332 patients (72.6%) received medications. Of those, medication errors occurred in 120 patients (36.1%). The more medications administered, the higher the risk of error (P<.01). Less errors occurred in trauma patients (P=.041).
More medication errors occur in the ED than in the emergency vehicles. Patients treated with multiple medications are more prone to medication errors.
药物错误是医源性药物不良事件的常见原因。在院前治疗期间药物错误的发生率和性质尚未完全描述。
本研究的目的是描述成人在院前急救和急诊科接受治疗期间药物错误的发生率和特征，并确定这些环境下药物错误的危险因素。
这是一项回顾性研究，纳入了由以色列一所大学附属医院的紧急医疗服务机构转至急诊科的成年患者。由两名评审员分别独立审查在移动重症监护室和急诊科给予的药物，以判断是否发生了错误。主要结局是每位患者的药物错误数量。次要结局是错误的类型和严重程度以及与药物错误发生率增加相关的变量。
在研究期间，有 1837 名患者由移动重症监护室车辆转至急诊科。随机选择 536 份患者病历（29%）进行审查；有 65 份病历（12.12%）无法找到；因此，共审查了 471 份病历。在急救车上，有 188 名患者（45.63%）接受了药物治疗；其中，12.76%（24 名患者）发生了药物错误。给予的药物数量和较长的转运时间与更高的错误风险相关（P<.01 和 P=.011）。急救车上有医生并不能改变错误风险（P=.95）。在急诊科，有 332 名患者（72.6%）接受了药物治疗。其中，有 120 名患者（36.1%）发生了药物错误。给予的药物越多，发生错误的风险越高（P<.01）。创伤患者发生的错误较少（P=.041）。
在急诊科发生的药物错误多于急救车上。接受多种药物治疗的患者更容易发生药物错误。
