Erstad Brian L, Patanwala Asad E, Theodorou Andreas A
Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, 85721-0207, USA.
Curr Drug Saf. 2012 Jul;7(3):238-46. doi: 10.2174/157488612803251270.
To categorize and synthesize medication safety event detection methods in the critically ill in order to provide clinicians and administrators with approaches to event detection that are intended to expand and complement traditional voluntary reporting systems.
A literature search of OvidMEDLINE was performed to identify articles related to medication safety involving critically ill patients in the intensive care unit setting. The inclusion of articles was restricted to comparative studies. The bibliographies of all retrieved articles were reviewed to obtain additional articles of relevance. The various event detection methods were compared by: evidence supporting their use; number, type and severity of events detected; phase of the medication use process in which events were detected; and ease and cost of implementation. Major limitations of each method were also collated.
There are a number of methods that can be used to identify medication safety events in the critically ill. These can broadly be categorized as: 1) voluntary reporting, 2) record review, 3) rules/triggers and 4) direct observation and 5) interviews/surveys. Relatively few studies have directly compared these assessment methods in the ICU setting, although the limitations of the traditional voluntary reporting system as the sole method of event detection are well established. Although not truly dichotomous, these methods can be broken down into more proactive and reactive approaches. Rules/triggers and direct observation of the medication use process in the ICU are examples of proactive approaches to event detection, while the traditional unsolicited voluntary reporting is typically reactive. However, each of the event detection methods has advantages and disadvantages, so the methods should not be considered mutually exclusive with respect to obtaining information about medication safety.
Given the limitations of traditional voluntary reporting systems, a multimodal approach used to identify medication safety events is most likely to capture the largest number and type of events. We would advise not trying to implement additional approaches beyond voluntary reporting systems all at once. This would be difficult and costly. Rather, we suggest a systematic implementation of additional event detection approaches that takes into account hospital-specific considerations.
对重症患者用药安全事件检测方法进行分类和综合，以便为临床医生和管理人员提供事件检测方法，旨在扩展和补充传统的自愿报告系统。
对Ovid MEDLINE进行文献检索，以识别与重症监护病房环境中重症患者用药安全相关的文章。纳入的文章仅限于比较研究。对所有检索到的文章的参考文献进行审查，以获取其他相关文章。通过以下方面比较各种事件检测方法：支持其使用的证据；检测到的事件的数量、类型和严重程度；检测到事件的用药过程阶段；以及实施的难易程度和成本。还整理了每种方法的主要局限性。
有多种方法可用于识别重症患者的用药安全事件。这些方法大致可分为：1）自愿报告，2）记录审查，3）规则/触发因素，4）直接观察，以及5）访谈/调查。尽管传统的自愿报告系统作为唯一的事件检测方法的局限性已得到充分证实，但相对较少的研究在重症监护病房环境中直接比较这些评估方法。虽然并非真正的二分法，但这些方法可分为更主动和被动的方法。规则/触发因素以及对重症监护病房用药过程的直接观察是事件检测的主动方法的示例，而传统的主动自愿报告通常是被动的。然而，每种事件检测方法都有其优缺点，因此在获取用药安全信息方面，这些方法不应被视为相互排斥。
鉴于传统自愿报告系统的局限性，用于识别用药安全事件的多模式方法最有可能捕获最多数量和类型的事件。我们建议不要一次性尝试实施除自愿报告系统之外的其他方法。这将既困难又昂贵。相反，我们建议系统地实施其他事件检测方法，并考虑医院的具体情况。
