Paediatric Therapeutics Program, School of Women’s and Children’s Health, University of New South Wales, New South Wales, Australia.
Pediatrics. 2012 May;129(5):e1334-42. doi: 10.1542/peds.2011-1902. Epub 2012 Apr 2.
To develop and test an evidence-based model for reducing medication errors and harm in hospitalized children.
Prospective interrupted time series study evaluating the effectiveness of a multifaceted, staged intervention over 4 years in a major urban pediatric referral hospital. Guidelines for safe pediatric prescribing were implemented by using an evidence-based model. Key components included early clinician engagement and improved multidisciplinary communication, consensus development, interactive education, and timely data feedback by using iterative Plan-Do-Study-Act cycles. Impact on medication error and harm (adverse drug events, [ADEs]) was measured by using standard definitions and a multimethod approach. Prospective data from voluntary reports by nursing, medical, and pharmacy staff and intensive chart review were combined. All data were reviewed by a multidisciplinary panel, including causality assessments for ADEs.
Reviewed over 3 time periods were 1011 patients with 6651 medication orders. Total ADEs decreased by > 50% in the first year and this was maintained at 4 years. Greatest improvements were in potential ADEs, which decreased from 12.26 per 100 patients at baseline to 4.60 per 100 patients at 4 years (P < .05). Total medication errors decreased from 4.51 per 100 orders at baseline to 2.78 per 100 orders at 4 years (P < .05). Prescribing errors decreased by 65%, from 4.07 per 100 orders at baseline to 2.05 orders at 4 years (P < .05).
A multifaceted, evidence-based model for safe prescribing guideline implementation, engaging multidisciplinary clinicians, was effective in reducing medication error and harm in hospitalized children, resulting in sustained long-term improvement.
开发并测试一种基于证据的模型，以减少住院儿童的用药错误和伤害。
前瞻性的中断时间序列研究，评估了在一家主要城市儿科转诊医院实施了 4 年的多方面、分阶段干预的有效性。通过使用基于证据的模型来实施安全儿科处方指南。关键组成部分包括早期临床医生的参与以及改善多学科沟通、共识制定、互动教育和通过迭代计划-执行-研究-行动循环及时提供数据反馈。通过使用标准定义和多方法方法来衡量药物错误和伤害（药物不良事件，[ADE]）的影响。
审查了 3 个时间段内的 1011 名患者，共 6651 份医嘱。第一年 ADE 总数减少了 50%以上，这一数字在 4 年内得以维持。最大的改进是潜在的 ADE，从基线时的每 100 名患者 12.26 例降至 4 年时的每 100 名患者 4.60 例（P<.05）。总用药错误从基线时的每 100 份医嘱 4.51 例降至 4 年时的每 100 份医嘱 2.78 例（P<.05）。开处方错误减少了 65%，从基线时的每 100 份医嘱 4.07 例降至 4 年时的每 100 份医嘱 2.05 例（P<.05）。
一种多方面的、基于证据的安全处方指南实施模型，吸引了多学科临床医生，有效地减少了住院儿童的用药错误和伤害，从而实现了持续的长期改善。
