Kantelhardt Pamela, Giese Alf, Kantelhardt Sven R
Department of Neurosurgery, University Medical Centre Mainz, Johannes-Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
Eur Spine J. 2016 Mar;25(3):740-7. doi: 10.1007/s00586-015-3878-1. Epub 2015 Mar 21.
In recent years, a marked increase of spinal operations prompted a debate on quality issues. Besides obvious factors, such as the surgical technique, medication safety has been identified as one of the major risk factors for patients undergoing anesthesia and surgery. While the issue has already been addressed by hospital pharmacist and anesthesiologists, the prescription of correct medication remains within the surgeons' responsibility. We, therefore, investigated medication-related errors in spinal instrumentation patients and applied current medication reconciliation strategies.
We performed a data survey on all patients undergoing spinal instrumentation in 2011. Risk factors for medication safety were identified and prioritized. Specific counter-measures were introduced in 2012 and evaluated in 2013.
147 patients were included in the 2011 and 162 in the 2013 survey. As top five risk factors we identified the preoperative stopping of medication, recording the medication history, prescription process of postoperative analgetics and anticoagulants and the medication list at discharge. Specific counter-measures included standardization of preparations, doses and the prescription process and improving access to this information (online and via a smartphone application). In elective patients, recording the medication histories was delegated to a hospital pharmacist and informative flyers and posters were used to integrate the patients themselves into the process. Counter-measures directed against the first four risk factors resulted in a significant reduction of medication errors. The last risk factor was targeted by instructing the responsible staff only, which proved to be a rather ineffective measure.
Medication safety could be significantly improved by implementation of counter-measures specific to the identified risk factors.
近年来，脊柱手术数量显著增加，引发了关于质量问题的讨论。除了诸如手术技术等明显因素外，药物安全已被确定为接受麻醉和手术患者的主要风险因素之一。尽管医院药剂师和麻醉师已经解决了这个问题，但正确用药的处方责任仍在外科医生手中。因此，我们调查了脊柱内固定患者与用药相关的错误，并应用了当前的用药核对策略。
我们对2011年所有接受脊柱内固定的患者进行了数据调查。确定了药物安全的风险因素并进行了优先级排序。2012年引入了具体的应对措施，并于2013年进行了评估。
2011年调查纳入了147例患者，2013年调查纳入了162例患者。我们确定的前五大风险因素为术前停药、记录用药史、术后镇痛药和抗凝药的处方流程以及出院时的用药清单。具体的应对措施包括制剂、剂量和处方流程的标准化，以及改善获取这些信息的途径（在线和通过智能手机应用程序）。对于择期手术患者，将记录用药史的工作委托给医院药剂师，并使用信息传单和海报让患者自身参与到这个过程中。针对前四个风险因素的应对措施使用药错误显著减少。最后一个风险因素仅通过指导责任人员来解决，事实证明这是一个相当无效的措施。
通过实施针对已确定风险因素的应对措施，可显著提高用药安全性。
