Foster Megan E, Lighter Donald E, Godambe Ashok V, Edgerson Brandon, Bradley Randy, Godambe Sandip
Pharmacy, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee.
J Pediatr Pharmacol Ther. 2013 Jan;18(1):53-62. doi: 10.5863/1551-6776-18.1.53.
To determine the effects of a resident physician educational program in a pediatric emergency department (ED) on pharmacy interventions and medication errors, particularly dose adjustments, order clarifications, and adverse drug events (ADE).
The ED pharmacist recorded all interventions and medication errors on weekdays from 3 to 11 pm during a 9-month period, consisting of a preobservational (Quarter 1), observational (Quarter 2), and interventional (Quarter 3) phases. Program implementation occurred in Quarter 3, with an initial 3-hour lecture during the ED orientation, followed by daily patient case discussions. Weekly interventions and errors were analyzed using statistical process control u-chart analyses. Chi-square analyses of independence were also performed. Resident and ED staff feedback on the program was obtained through anonymous internet-based surveys.
A total of 3507 interventions were recorded during the 9-month period. Chi-square approximation and interval estimation of odds ratio showed a statistically significant decrease between Quarters 1 and 3 in the number of dose adjustments (95% confidence interval [CI], 0.324-0.689) and order clarifications (95% CI, 0.137 to 0.382) after initiation of the program. The decline in ADE, while not as substantial (95% CI, 0.003 to 1.078), still achieved a level of significance (90% CI, 0.006 to 0.674). Survey results were positive toward the program.
The implementation of a resident physician educational program in our pediatric ED significantly decreased the number of medication errors, increased resident physician awareness of the potential for errors, and increased ED pharmacist utilization.
确定儿科急诊科住院医师教育项目对药学干预和用药错误的影响，尤其是剂量调整、医嘱澄清和药物不良事件（ADE）。
急诊科药师在9个月期间工作日的下午3点至11点记录所有干预措施和用药错误，包括观察前阶段（第1季度）、观察阶段（第2季度）和干预阶段（第3季度）。项目实施在第3季度进行，在急诊科入职培训期间最初进行3小时讲座，随后进行每日病例讨论。使用统计过程控制u图分析每周的干预措施和错误。还进行了独立性卡方分析。通过基于互联网的匿名调查获得住院医师和急诊科工作人员对该项目的反馈。
在9个月期间共记录了3507次干预措施。卡方近似法和比值比的区间估计显示，项目启动后，第1季度和第3季度之间剂量调整数量（95%置信区间[CI]，0.324 - 0.689）和医嘱澄清数量（95%CI，0.137至0.382）有统计学显著下降。ADE的下降虽不那么显著（95%CI，0.003至1.078），但仍达到显著水平（90%CI，0.006至0.674）。调查结果对该项目呈积极态度。
在我们的儿科急诊科实施住院医师教育项目显著减少了用药错误数量，提高了住院医师对潜在错误的认识，并增加了急诊科药师的利用率。
