Desai Rishi J, Williams Charlotte E, Greene Sandra B, Pierson Stephanie, Hansen Richard A
Division of Pharmacoepidemiology and Pharmacoeconomics, Harvard Medical School and Brigham & Women's Hospital, USA.
J Healthc Risk Manag. 2013;33(1):33-43. doi: 10.1002/jhrm.21116.
Appropriate and safe use of medications is an important aspect of quality of care in nursing home patients. Because of their complex medication use process, anticoagulants are prone to medication errors in the frail elderly. Therefore, we designed this study to characterize anticoagulant medication errors and to evaluate their association with patient harm using individual medication error incidents reported by all North Carolina nursing homes to the Medication Error Quality Initiative (MEQI) during fiscal years 2010-2011. Characteristics, causes, and specific outcomes of harmful anticoagulant medication errors were reported as frequencies and proportions and compared between anticoagulant errors and other medication errors using chi-square tests. A multivariate logistic regression model explored the relationship between anticoagulant medication errors and patient harm, controlling for patient- and error-related factors.
药物的合理与安全使用是疗养院患者护理质量的一个重要方面。由于抗凝剂的用药过程复杂，在体弱老年人中容易出现用药错误。因此，我们开展了本研究，利用北卡罗来纳州所有疗养院在2010 - 2011财政年度向药物错误质量改进计划（MEQI）报告的个体用药错误事件，来描述抗凝剂用药错误的特征，并评估其与患者伤害的关联。有害抗凝剂用药错误的特征、原因和具体结果以频率和比例报告，并使用卡方检验在抗凝剂错误与其他用药错误之间进行比较。一个多变量逻辑回归模型探讨了抗凝剂用药错误与患者伤害之间的关系，并对患者和错误相关因素进行了控制。
