Benkelfat Rislaine, Gouin Serge, Larose Guylaine, Bailey Benoit
Division of Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
J Emerg Med. 2013 Sep;45(3):419-25. doi: 10.1016/j.jemermed.2012.11.069. Epub 2013 Mar 9.
Despite the publication of recent guidelines for anaphylaxis management, many studies show that physicians are still not at ease with the management of anaphylaxis.
To evaluate the rate and severity of medication errors before and after implementation of a standard order form for anaphylaxis management.
A before-and-after study was conducted. All children <18 years of age presenting to a tertiary care pediatric hospital Emergency Department with anaphylaxis between September 2007 and November 2010 were included. Patients were divided into two groups according to intervention (Pre and Post). Intervention consisted of the implementation of a standard order form (SOF) for anaphylaxis management. The post-intervention group was further sub-divided into SOF+ (when the SOF was used) and SOF- (when the SOF was not used).
A total of 96 medical charts were reviewed. There were 31 patients in Pre and 65 in Post (29 in SOF+ and 36 in SOF-). A total of 243 drugs were ordered. Thirty-five percent (85/243) of these orders contained at least one medication error. Fifty-five percent (47/85) were dosage errors. The rate of medication errors was the same between Pre and Post (60% vs. 59%, p = 0.95). However, the rate of dosage errors was significantly reduced when the SOF was used (21% in SOF+ vs. 50% in Pre, p = 0.02 and 21% in SOF+ vs. 50% in SOF-, p = 0.02).
Medication errors in the management of anaphylaxis were frequent. Use of an SOF significantly reduced the rate of dosage errors.
尽管近期已发布过敏反应管理指南，但许多研究表明，医生在过敏反应管理方面仍不自在。
评估实施过敏反应管理标准医嘱单前后用药错误的发生率和严重程度。
进行了一项前后对照研究。纳入2007年9月至2010年11月期间在一家三级护理儿科医院急诊科就诊的所有18岁以下过敏反应患儿。根据干预情况（术前和术后）将患者分为两组。干预措施包括实施过敏反应管理标准医嘱单（SOF）。干预后组进一步细分为SOF+组（使用SOF时）和SOF-组（未使用SOF时）。
共审查了96份病历。术前有31例患者，术后有65例（SOF+组29例，SOF-组36例）。共开出243种药物。其中35%（85/243）的医嘱至少包含一处用药错误。55%（47/85）为剂量错误。术前和术后用药错误率相同（60%对59%，p = 0.95）。然而，使用SOF时剂量错误率显著降低（SOF+组为21%，术前为50%，p = 0.02；SOF+组为21%，SOF-组为50%，p = 0.02）。
过敏反应管理中的用药错误很常见。使用SOF可显著降低剂量错误率。
