Ali Mostafa A Sayed, Lobos Christina Milad, Abdelmegid Mohamed Aboel-Kassem F, El-Sayed Ahmed Moustafa
Department of Clinical Pharmacy, Faculty of Pharmacy, Assiut University, Assiut, 71526, Egypt.
Department of Cardiovascular Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
Int J Clin Pharm. 2017 Jun;39(3):542-550. doi: 10.1007/s11096-017-0457-z. Epub 2017 Apr 3.
Background Cardiovascular medications have been commonly associated with medication errors. Objective The objective of this study was to investigate the incidence and predictors of medication errors in patients with acute coronary syndrome. Setting the coronary care unit of a university teaching hospital. Methods This was a prospective observational study on 150 patients admitted to the coronary care unit between August 2014 and July 2015. Main outcome measure The principal outcome was the number (frequency) of encountered medication errors. Results Of total 5790 prescription items reviewed, 547 (9.4%) potential medication errors were identified of which 523 (9.0%) were prescribing errors and 24 were monitoring errors. The most frequent prescribing errors were dosing errors (231, 42.2%) followed by loading dose omission error (91, 16.6%), omission of essential drugs on 1st day (43, 7.9%), and timing error (40, 7.3%). Errors frequently encountered with drugs such as aspirin, enoxaparin, beta-blockers followed by angiotensin-converting enzyme inhibitors and clopidogrel. Multivariate logistic regression analysis revealed that renal impairment (OR 6.02; 95% CI 1.4-35.4; p = 0.02) and longer duration of hospital stay (OR 4.01; 95% CI 1.5-10.7; p = 0.005) were predictors of the higher incidence of medication errors. Conclusion Prescribing and monitoring errors in coronary care unit are frequent and avoidable, with the majority of errors were ranked to be of mild to moderate severity. Dosing errors, omission of essential drugs and monitoring errors were most common error types encountered. Dosage adjustment based on estimation of the glomerular filtration rate immediately after admission help avoiding dosage-related errors.
心血管药物常与用药错误相关。目的：本研究旨在调查急性冠脉综合征患者用药错误的发生率及预测因素。地点：一所大学教学医院的冠心病监护病房。方法：这是一项对2014年8月至2015年7月间入住冠心病监护病房的150例患者进行的前瞻性观察研究。主要结局指标：主要结局是所遇到的用药错误的数量（频率）。结果：在总共审查的5790条处方中，识别出547条（9.4%）潜在用药错误，其中523条（9.0%）为处方错误，24条为监测错误。最常见的处方错误是剂量错误（231条，42.2%），其次是负荷剂量遗漏错误（91条，16.6%）、入院首日基本药物遗漏（43条，7.9%）和时间错误（40条，7.3%）。阿司匹林、依诺肝素、β受体阻滞剂以及血管紧张素转换酶抑制剂和氯吡格雷等药物经常出现错误。多因素逻辑回归分析显示，肾功能损害（比值比6.02；95%置信区间1.4 - 35.4；p = 0.02）和住院时间延长（比值比4.01；95%置信区间1.5 - 10.7；p = 0.005）是用药错误发生率较高的预测因素。结论：冠心病监护病房的处方和监测错误很常见且可避免，大多数错误的严重程度为轻度至中度。剂量错误、基本药物遗漏和监测错误是最常见的错误类型。入院后立即根据肾小球滤过率估计进行剂量调整有助于避免与剂量相关的错误。
