Departments of Pediatrics, University of Massachusetts School of Medicine, Worcester, MA 01655, USA.
Pediatrics. 2013 May;131(5):e1405-14. doi: 10.1542/peds.2012-2434. Epub 2013 Apr 29.
As home medication use increases, medications previously managed by nurses are now managed by patients and their families. Our objective was to describe the types of errors occurring in the home medication management of children with cancer.
In a prospective observational study at 3 pediatric oncology clinics in the northeastern and southeastern United States, patients undergoing chemotherapy and their parents were recruited from November 2007 through April 2011. We reviewed medical records and checked prescription doses. A trained nurse visited the home, reviewed medication bottles, and observed administration. Two physicians independently made judgments regarding whether an error occurred and its severity. Overall rates of errors were weighted to account for clustering within sites.
We reviewed 963 medications and observed 242 medication administrations in the homes of 92 patients. We found 72 medication errors. Four errors led to significant patient injury. An additional 40 errors had potential for injury: 2 were life-threatening, 13 were serious, and 25 were significant. Error rates varied between study sites (40-121 errors per 100 patients); the weighted overall rate was 70.2 errors per 100 patients (95% confidence interval [CI]: 58.9-81.6). The weighted rate of errors with injury was 3.6 (95% CI: 1.7-5.5) per 100 patients and with potential to injure the patient was 36.3 (95% CI: 29.3-43.3) per 100 patients. Nonchemotherapy medications were more often involved in an error than chemotherapy.
Medication errors were common in this multisite study of outpatient pediatric cancer care. Rates of preventable medication-related injuries in this outpatient population were comparable or higher than those found in studies of hospitalized patients.
随着家庭用药的增加，以前由护士管理的药物现在由患者及其家属管理。我们的目的是描述儿童癌症患者家庭用药管理中出现的错误类型。
在美国东北部和东南部的 3 个儿科肿瘤诊所进行了一项前瞻性观察研究，从 2007 年 11 月至 2011 年 4 月招募正在接受化疗的患者及其父母。我们查阅了病历并检查了处方剂量。一名经过培训的护士会去患者家中，检查药物瓶，并观察给药过程。两位医生独立判断是否发生了错误以及错误的严重程度。总体错误率进行了加权处理，以考虑到站点内的聚类。
我们共审查了 963 种药物，并观察了 92 名患者家中的 242 次药物管理过程。我们发现了 72 种药物错误。有 4 种错误导致了患者的严重伤害。还有 40 种错误具有潜在的伤害风险：2 种是危及生命的，13 种是严重的，25 种是重大的。研究点之间的错误发生率不同（每 100 名患者中有 40-121 种错误）；加权后的总体错误率为每 100 名患者 70.2 种错误（95%置信区间[CI]：58.9-81.6）。有伤害的错误发生率为每 100 名患者 3.6（95% CI：1.7-5.5），有潜在伤害风险的错误发生率为每 100 名患者 36.3（95% CI：29.3-43.3）。非化疗药物比化疗药物更容易发生错误。
在这项多地点的儿科癌症门诊护理研究中，药物错误很常见。在这个门诊人群中，可预防的与药物相关的伤害发生率与住院患者研究中的发生率相当或更高。
