Department of Pharmacy, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France.
PLoS One. 2013 Jun 20;8(6):e68856. doi: 10.1371/journal.pone.0068856. Print 2013.
Drug administration in the hospital setting is the last barrier before a possible error reaches the patient.
We aimed to analyze the prevalence and nature of administration error rate detected by the observation method.
Embase, MEDLINE, Cochrane Library from 1966 to December 2011 and reference lists of included studies.
Observational studies, cross-sectional studies, before-and-after studies, and randomized controlled trials that measured the rate of administration errors in inpatients were included.
Two reviewers (senior pharmacists) independently identified studies for inclusion. One reviewer extracted the data; the second reviewer checked the data. The main outcome was the error rate calculated as being the number of errors without wrong time errors divided by the Total Opportunity for Errors (TOE, sum of the total number of doses ordered plus the unordered doses given), and multiplied by 100. For studies that reported it, clinical impact was reclassified into four categories from fatal to minor or no impact. Due to a large heterogeneity, results were expressed as median values (interquartile range, IQR), according to their study design.
Among 2088 studies, a total of 52 reported TOE. Most of the studies were cross-sectional studies (N=46). The median error rate without wrong time errors for the cross-sectional studies using TOE was 10.5% [IQR: 7.3%-21.7%]. No fatal error was observed and most errors were classified as minor in the 18 studies in which clinical impact was analyzed. We did not find any evidence of publication bias.
Administration errors are frequent among inpatients. The median error rate without wrong time errors for the cross-sectional studies using TOE was about 10%. A standardization of administration error rate using the same denominator (TOE), numerator and types of errors is essential for further publications.
医院环境中的药物给药是在错误到达患者之前的最后一道防线。
我们旨在分析通过观察法检测到的给药错误率的发生率和性质。
从 1966 年至 2011 年 12 月，我们检索了 Embase、MEDLINE 和 Cochrane 图书馆，并查阅了纳入研究的参考文献列表。
纳入了观察性研究、横断面研究、前后对照研究和随机对照试验，这些研究测量了住院患者的给药错误率。
两位（资深药剂师）审查员独立确定纳入的研究。一位审查员提取数据；第二位审查员检查数据。主要结局是计算的错误率，错误率被定义为没有错误时间错误的错误数除以总错误机会（TOE，给定的总剂量数加上未给定的剂量之和），并乘以 100。对于报告了该结果的研究，临床影响被重新分类为从致命到轻微或无影响的四个类别。由于存在很大的异质性，根据研究设计，结果表示为中位数（四分位距，IQR）。
在 2088 项研究中，共有 52 项报告了 TOE。大多数研究是横断面研究（N=46）。使用 TOE 的横断面研究中，没有错误时间错误的错误率中位数为 10.5% [IQR：7.3%-21.7%]。在分析了临床影响的 18 项研究中，没有观察到致命错误，大多数错误被归类为轻微。我们没有发现任何发表偏倚的证据。
住院患者中给药错误很常见。使用 TOE 的横断面研究中，没有错误时间错误的错误率中位数约为 10%。为了进一步发表，使用相同的分母（TOE）、分子和错误类型标准化给药错误率是至关重要的。
