Basco William T, Garner Sandra S, Ebeling Myla, Freeland Katherine D, Hulsey Thomas C, Simpson Kit
Department of Pediatrics, College of Medicine, The Medical University of South Carolina, Charleston, SC.
Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Charleston, SC.
Acad Pediatr. 2016 Mar;16(2):183-91. doi: 10.1016/j.acap.2015.06.014. Epub 2015 Sep 26.
Look-alike, sound-alike (LASA) drug name substitution errors in children may pose potentially severe consequences. Our objective was to determine the degree of potential harm pediatricians ascribe to specific ambulatory LASA drug substitution errors.
We developed a unified list of LASA pairs from published sources, removing selected drugs on the basis of preparation type (eg, injectable drugs). Using a modified Delphi method over 3 rounds, 38 practicing pediatricians estimated degree of potential harm that might occur should a patient receive the delivered drug in error and the degree of potential harm that might occur from not receiving the intended drug.
We identified 3550 published LASA drug pairs. A total of 1834 pairs were retained for the Delphi surveys, and 608 drug pairs were retained for round 3. Final scoring demonstrated that participants were able to identify pairs where the substitutions represented high risk of harm for receiving the delivered drug in error (eg, did not receive methylphenidate/received methadone), high risk of harm for not receiving the intended drug (eg, did not receive furosemide/received fosinopril), and pairs where the potential harm was high from not receiving the intended drug and from erroneously receiving the delivered drug (eg, did not receive albuterol/received labetalol).
Pediatricians have identified LASA drug substitutions that pose a high potential risk of harm to children. These results will allow future efforts to prioritize pediatric LASA errors that can be screened prospectively in outpatient pharmacies.
儿童用药中形似、音似（LASA）药品名称替换错误可能会带来潜在的严重后果。我们的目的是确定儿科医生认为特定门诊LASA药品替换错误可能造成的潜在危害程度。
我们从已发表的资料中制定了一份LASA药品对的统一清单，并根据制剂类型（如注射用药品）剔除了部分药品。通过三轮改进的德尔菲法，38名执业儿科医生估计了患者误服所发药品可能发生的潜在危害程度，以及未服用预期药品可能发生的潜在危害程度。
我们识别出3550对已发表的LASA药品对。共有1834对被保留用于德尔菲调查，608对药品对被保留用于第三轮调查。最终评分表明，参与者能够识别出以下几类药品对：替换后误服所发药品存在高危害风险（如未服用哌甲酯/服用了美沙酮）、未服用预期药品存在高危害风险（如未服用呋塞米/服用了福辛普利），以及未服用预期药品和误服所发药品均存在高潜在危害的药品对（如未服用沙丁胺醇/服用了拉贝洛尔）。
儿科医生已识别出对儿童有高潜在危害风险的LASA药品替换情况。这些结果将有助于未来对可在门诊药房进行前瞻性筛查的儿科LASA错误进行优先级排序。
