入住儿科心血管重症监护病房的成人先天性心脏病患者的处方错误。
Prescribing errors in adult congenital heart disease patients admitted to a pediatric cardiovascular intensive care unit.
作者信息
Echeta Genevieve, Moffett Brady S, Checchia Paul, Benton Mary Kay, Klouda Leda, Rodriguez Fred H, Franklin Wayne
机构信息
Department of Pharmacy, Texas Children's Hospital, Houston, Tex, USA.
出版信息
Congenit Heart Dis. 2014 Mar-Apr;9(2):126-30. doi: 10.1111/chd.12106. Epub 2013 Jun 18.
BACKGROUND
Adults with congenital heart disease (CHD) are often cared for at pediatric hospitals. There are no data describing the incidence or type of medication prescribing errors in adult patients admitted to a pediatric cardiovascular intensive care unit (CVICU).
METHODS
A review of patients >18 years of age admitted to the pediatric CVICU at our institution from 2009 to 2011 occurred. A comparator group <18 years of age but >70 kg (a typical adult weight) was identified. Medication prescribing errors were determined according to a commonly used adult drug reference. An independent panel consisting of a physician specializing in the care of adult CHD patients, a nurse, and a pharmacist evaluated all errors. Medication prescribing orders were classified as appropriate, underdose, overdose, or nonstandard (dosing per weight instead of standard adult dosing), and severity of error was classified.
RESULTS
Eighty-five adult (74 patients) and 33 pediatric admissions (32 patients) met study criteria (mean age 27.5 ± 9.4 years, 53% male vs. 14.9 ± 1.8 years, 63% male). A cardiothoracic surgical procedure occurred in 81.4% of admissions. Adult admissions weighed less than pediatric admissions (72.8 ± 22.4 kg vs. 85.6 ± 14.9 kg, P < .01) but hospital length of stay was similar. (Adult 6 days [range 1-216 days]; pediatric 5 days [Range 2-123 days], P = .52.) A total of 112 prescribing errors were identified and they occurred less often in adults (42.4% of admissions vs. 66.7% of admissions, P = .02). Adults had a lower mean number of errors (0.7 errors per adult admission vs. 1.7 errors per pediatric admission, P < .01). Prescribing errors occurred most commonly with antimicrobials (n = 27). Underdosing was the most common category of prescribing error. Most prescribing errors were determined to have not caused harm to the patient.
CONCLUSIONS
Prescribing errors occur frequently in adult patients admitted to a pediatric CVICU but occur more often in pediatric patients of adult weight.
背景
患有先天性心脏病（CHD）的成人通常在儿科医院接受治疗。目前尚无关于入住儿科心血管重症监护病房（CVICU）的成年患者用药处方错误发生率或类型的数据。
方法
回顾了2009年至2011年在我院儿科CVICU住院的18岁以上患者。确定了一个年龄小于18岁但体重>70千克（典型成年人体重）的对照组。根据常用的成人药物参考资料确定用药处方错误。一个由专门负责成年CHD患者护理的医生、一名护士和一名药剂师组成的独立小组对所有错误进行了评估。用药处方医嘱被分类为适当、剂量不足、剂量过量或不标准（按体重给药而非标准成人剂量），并对错误的严重程度进行了分类。
结果
85名成年患者（74例）和33名儿科患者（32例）符合研究标准（平均年龄27.5±9.4岁，男性占53%；对比平均年龄14.9±1.8岁，男性占63%）。81.4%的入院患者接受了心胸外科手术。成年患者的体重低于儿科患者（72.8±22.4千克对85.6±14.9千克，P<.01），但住院时间相似。（成年患者6天[范围1 - 216天]；儿科患者5天[范围2 - 123天]，P = .52）。共识别出112处用药处方错误，且这些错误在成年患者中发生的频率较低（成年患者入院中有42.4%出现错误，儿科患者入院中有66.7%出现错误，P = .02）。成年患者的平均错误数较低（成年患者每次入院0.7个错误，儿科患者每次入院1.7个错误，P<.01）。用药处方错误最常发生在抗菌药物方面（n = 27）。剂量不足是最常见的处方错误类型。大多数处方错误被确定未对患者造成伤害。
结论
入住儿科CVICU的成年患者经常发生用药处方错误，但在成年体重的儿科患者中发生得更频繁。
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