College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Drug Saf. 2012 Aug 1;35(8):677-83. doi: 10.1007/BF03261964.
The omission of charted (prescribed) doses for hospitalized patients is an important problem in the UK. Inappropriate drug omission can clearly lead to harm from lack of therapeutic effect. However, healthcare professionals administering medicines may decide that omission of a dose is appropriate in certain circumstances, e.g. when patients show signs of a possible adverse drug reaction (ADR).
The aim of this study was to characterize dose omissions to understand the factors that influence non-administration of therapy and to determine the proportion of doses that are appropriately omitted due to ADRs.
We used data from a bespoke hospital-wide electronic prescribing and administration system at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. We extracted data on 6.01 million drug administrations during 2010 and then randomly selected four 7-day periods, concentrating on doses that were charted but not given. Omitted medicines were counted if either there was a charted 'non-administration' (i.e. an active acknowledgement of the omitted dose) or there was no charting of that dose (i.e. no record of either administration or omission). Paused medicines were not counted. When a dose was omitted, staff indicated the reasons for non-administration using codes ('hard coded') or free text in the electronic system. We used both to compare the contribution of different factors, including ADRs, to the total rates of dose omissions.
In the four 7-day periods analysed, 60 763 (12.4%) of the 491 894 charted doses were omitted. The most common code was 'patient refused drug' (45.4%). Only 1.6% of doses were omitted for reasons of patient safety, of which 4 in 1000 omissions were coded as directly due to an ADR.
Measures to improve the quality of care should seek to reduce dose omissions, but in some cases omission may be rational. Electronic medication administration records allow for detailed analysis of decisions made by healthcare professionals at the point of administration. While dose omissions related to ADRs are uncommon, they are important both for patient safety and for therapeutic decision making.
在英国，住院患者医嘱（规定）剂量的遗漏是一个重要问题。不合适的药物遗漏显然会导致缺乏治疗效果而产生危害。然而，给患者用药的医护人员在某些情况下可能会决定遗漏某一剂，例如当患者出现可能的药物不良反应（ADR）迹象时。
本研究旨在描述剂量遗漏情况，以了解影响未给药的因素，并确定因 ADR 而适当遗漏的剂量比例。
我们使用了英国伯明翰大学医院 NHS 基金会信托的定制全院电子医嘱和给药系统的数据。我们提取了 2010 年 601 万次药物给药的数据，然后随机选择了四个 7 天的时间段，集中研究了医嘱但未给药的剂量。如果有医嘱“未给药”（即主动确认遗漏剂量）或未记录该剂量（即未记录给药或遗漏），则算作遗漏药物。暂停药物不计入。当剂量被遗漏时，工作人员使用电子系统中的代码（“硬编码”）或自由文本记录未给药的原因。我们使用这两种方法来比较不同因素（包括 ADR）对总剂量遗漏率的贡献。
在分析的四个 7 天时间段中，491894 个医嘱剂量中有 60763 个（12.4%）被遗漏。最常见的代码是“患者拒绝药物”（45.4%）。只有 1.6%的剂量因患者安全原因被遗漏，其中每 1000 次遗漏中有 4 次被编码为直接由 ADR 引起。
提高护理质量的措施应旨在减少剂量遗漏，但在某些情况下遗漏可能是合理的。电子用药管理记录允许在给药点对医护人员的决策进行详细分析。虽然与 ADR 相关的剂量遗漏并不常见，但它们对患者安全和治疗决策都很重要。
