Ajemigbitse Adetutu A, Omole Moses Kayode, Erhun Wilson O
Department of Pharmacy, National Hospital Abuja, Abuja, Nigeria.
Ann Afr Med. 2016 Jan-Mar;15(1):1-6. doi: 10.4103/1596-3519.161722.
BACKGROUND/OBJECTIVE: Accurate medication prescribing important to avoid errors and ensure best possible outcomes. This is a report of assessment of the impact of providing feedback and educational intervention on prescribing error types and rates in routine practice.
Doctors' prescriptions from selected wards in two tertiary hospitals in central Nigeria were prospectively reviewed for a 6-month period and assessed for errors; grouped into six categories. Intervention was by providing feedback and educational outreach on the specialty/departmental level at one hospital while the other acted as the control. Chi-squared statistics was used to compare prescribing characteristics pre- and post-intervention.
At baseline, error rate was higher at the control site. At the intervention site, statistically significant reductions were obtained for errors involving omission of route of administration (P < 0.001), under dose (P = 0.012), dose adjustment in renal impairment (P = 0.019), ambiguous orders (P < 0.001) and drug/drug interaction (P < 0.001) post intervention though there was no change in mean error rate post intervention (P = 0.984). Though House Officers and Registrars wrote most prescriptions, highest reduction in prescribing error rates post intervention was by the registrars (0.93% to 0.29%, P < 0.001).
Writing prescriptions that lacked essential details was common. Intervention resulted in modest changes. Routinely providing feedback and continuing prescriber education will likely sustain error reduction.
背景/目的:准确的用药处方对于避免错误和确保可能的最佳治疗效果至关重要。这是一份关于在常规实践中提供反馈和教育干预对处方错误类型和发生率影响的评估报告。
前瞻性地回顾了尼日利亚中部两家三级医院选定病房医生在6个月期间的处方,并对错误进行评估;错误分为六类。在一家医院的专科/科室层面提供反馈和教育推广作为干预措施,另一家医院作为对照。采用卡方统计比较干预前后的处方特征。
基线时,对照站点的错误率较高。在干预站点,干预后涉及遗漏给药途径(P < 0.001)、剂量不足(P = 0.012)、肾功能损害时的剂量调整(P = 0.019)、医嘱不明确(P < 0.001)和药物/药物相互作用(P < 0.001)的错误有统计学意义的降低,尽管干预后平均错误率没有变化(P = 0.984)。虽然住院医生和注册医生开具的处方最多,但干预后处方错误率下降最多的是注册医生(从0.93%降至0.29%,P < 0.001)。
开具缺乏基本细节的处方很常见。干预导致了适度的变化。常规提供反馈和持续进行处方医生教育可能会持续降低错误率。