Campino Ainara, Arranz Casilda, Unceta Maria, Rueda Miguel, Sordo Beatriz, Pascual Pilar, Lopez-de-Heredia Ion, Santesteban Elena
Hospital Pharmacy, Hospital Universitario Cruces, Plaza de Cruces s/n, 48903, Barakaldo, Bizkaia, Spain.
Neonatal Intensive Care Unit, Department of Pediatrics, Hospital Universitario Cruces, Barakaldo, Spain.
Eur J Pediatr. 2016 Feb;175(2):203-10. doi: 10.1007/s00431-015-2615-4. Epub 2015 Aug 27.
This study assessed the rate of errors in intravenous medicine preparation at the bedside in neonatal intensive care units vs the preparation error rate in a hospital pharmacy service. We conducted a prospective observational study between June and September 2013. Ten Spanish neonatal intensive care units and one hospital pharmacy service participated in the study. Two types of preparation errors were considered: calculation errors and accuracy errors. A total of 522 samples were collected: 238 of vancomycin, 139 of gentamicin, 39 of phenobarbital and 88 of caffeine citrate preparations. Of these, 444 samples were collected by nurses in neonatal intensive care units, and 60 were provided by the hospital pharmacy service. Overall, 18 samples were excluded from the analysis. We detected calculation errors in 6/444 (1.35%) and accuracy errors in 243/444 (54.7%) samples from the neonatal intensive care units. In contrast, in samples from the hospital pharmacy service, no calculation errors were detected, but there were accuracy errors in 23/60 (38.3%) samples.
While calculation errors can be eliminated using protocols based on standard drug concentrations, accuracy error rates depend on several variables that affect both neonatal intensive care units and hospital pharmacy services.
Medication use is associated with a risk of errors and adverse events. Medication errors are more frequent and have more severe consequences in paediatric patients. Lack of knowledge of drug pharmacokinetics and pharmacodynamics in relation to physiological immaturity makes neonates more vulnerable to medication errors.
Calculation errors are avoided using concentration standard preparation protocols. Accuracy in the preparation process depends mainly on the degree to which commercial drug preparations meet current legal requirements and the syringes and preparation techniques used.
本研究评估了新生儿重症监护病房床边静脉用药配制的错误率与医院药房服务的配制错误率。我们在2013年6月至9月期间进行了一项前瞻性观察研究。十家西班牙新生儿重症监护病房和一家医院药房服务机构参与了该研究。考虑了两种类型的配制错误：计算错误和准确性错误。共收集了522个样本：238个万古霉素样本、139个庆大霉素样本、39个苯巴比妥样本和88个枸橼酸咖啡因制剂样本。其中，444个样本由新生儿重症监护病房的护士收集，60个由医院药房服务机构提供。总体而言，18个样本被排除在分析之外。我们在新生儿重症监护病房的444个样本中检测到6个（1.35%）计算错误和243个（54.7%）准确性错误。相比之下，在医院药房服务机构的样本中，未检测到计算错误，但在60个样本中有23个（38.3%）存在准确性错误。
虽然基于标准药物浓度的方案可以消除计算错误，但准确性错误率取决于影响新生儿重症监护病房和医院药房服务机构的多个变量。
用药与错误和不良事件风险相关。用药错误在儿科患者中更频繁且后果更严重。与生理不成熟相关的药物药代动力学和药效学知识的缺乏使新生儿更容易发生用药错误。
使用浓度标准配制方案可避免计算错误。配制过程中的准确性主要取决于商业药物制剂符合当前法律要求的程度以及所使用的注射器和配制技术。
