Beaudoin Francesca L, Merchant Roland C, Janicki Adam, McKaig Donald M, Babu Kavita M
Department of Emergency Medicine, Rhode Island Hospital, the Alpert Medical School of Brown University, Providence, RI.
Department of Emergency Medicine, Rhode Island Hospital, the Alpert Medical School of Brown University, Providence, RI.
Ann Emerg Med. 2015 Apr;65(4):423-31. doi: 10.1016/j.annemergmed.2014.11.016. Epub 2014 Dec 18.
We describe characteristics of patients with in-emergency department (ED) opioid-related adverse drug events, medication errors, and harm resulting from medication errors; identify patient-, provider-, and system-based factors associated with in-ED opioid-related medication errors and harm; and create a list of strategies to prevent future events.
This retrospective study was conducted at 2 urban academic EDs. Potential iatrogenic opioid overdoses were identified by querying the ED electronic medical record for cases when naloxone was administered after an opioid was administered in the ED. Cases involving medication errors resulting in harm were reviewed qualitatively for common patient-, provider-, and systems-based factors that might have contributed to the event.
Of 73 ED patients with in-ED opioid-related adverse events that required reversal with naloxone, 43 had a medication error resulting in harm. Patient-, provider-, and systems-based factors that might have contributed to the events included chronic health conditions that could predispose an individual to an opioid-related adverse event, failure to adjust opioid dosing in the elderly and for hepatic or renal impairment, multiple doses and routes of administration of opioids, coadministration of opioids with other sedating medications, and systems-based problems with patient handoffs and pharmacy oversight.
We identified patient-, provider-, and systems-based factors related to opioid-related adverse drug events and medication errors among ED patients who had received naloxone. The results from our assessment can be used to inform educational and policy initiatives aimed to prevent in-ED opioid-related adverse drug events and medication errors.
我们描述急诊科（ED）中与阿片类药物相关的不良药物事件、用药错误以及用药错误导致的伤害的患者特征；识别与急诊科内阿片类药物相关用药错误及伤害相关的患者、医护人员和系统因素；并制定一系列策略以预防未来此类事件的发生。
这项回顾性研究在两家城市学术性急诊科开展。通过查询急诊科电子病历中在急诊科使用阿片类药物后又使用纳洛酮的病例，来识别潜在的医源性阿片类药物过量情况。对涉及导致伤害的用药错误的病例，从可能导致该事件的常见患者、医护人员和系统因素方面进行定性审查。
在73例因急诊科内与阿片类药物相关不良事件而需要使用纳洛酮进行抢救的患者中，43例存在导致伤害的用药错误。可能导致这些事件的患者、医护人员和系统因素包括：可能使个体易发生与阿片类药物相关不良事件的慢性健康状况；未对老年人以及肝肾功能损害患者调整阿片类药物剂量；阿片类药物的多种剂量和给药途径；阿片类药物与其他镇静药物联合使用；以及患者交接和药房监管方面基于系统的问题。
我们识别出了在接受纳洛酮治疗的急诊科患者中，与阿片类药物相关不良药物事件及用药错误有关的患者、医护人员和系统因素。我们评估的结果可用于为旨在预防急诊科内阿片类药物相关不良药物事件及用药错误的教育和政策举措提供参考。
