Pharmacy Department, Austin Health, Studley Rd, Heidelberg, Victoria, Australia, 3084.
Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia.
J Eval Clin Pract. 2018 Aug;24(4):688-694. doi: 10.1111/jep.12944. Epub 2018 May 22.
RATIONALE, AIMS, AND OBJECTIVES: Whilst many dose omissions cause no patient harm, inappropriate dose omissions have been associated with increased length of hospital stay, risk of sepsis, and mortality. This study aimed to comprehensively describe the prevalence and nature of omitted doses overall and of high risk medication dose omissions in an organization using an electronic Medication Management System.
A retrospective cross-sectional study was undertaken in an Australian tertiary referral health service. All routinely documented electronic inpatient dose administration records from 1 July 2014 to 30 June 2015 were included. Period prevalence and characteristics of dose omissions overall and of high-risk medication dose omissions were determined.
During the study period, 3.3 million inpatient doses were scheduled for administration, with doses endorsed as "not given" comprising 6.2% of all scheduled doses. Non-valid dose omissions (medication not available or no justification documented) comprised 1.2% of scheduled doses. Patient refusal accounted for one third of all dose omissions, while for 12% no explanation was provided and 7% were endorsed "medication not available". High-risk medications accounted for 20% of all dose omissions. One in 20 antimicrobial doses scheduled were omitted, and of these, 17% were due to patient refusal.
The period prevalence of dose omissions in this large study after electronic Medication Management System implementation is similar to that found when paper charts were used. Although most dose omissions appear appropriate, many orders were not given due to patient refusal or with no documented justification. Interventions to minimize unintentional dose omissions are indicated.
背景、目的和目标：尽管许多剂量遗漏不会对患者造成伤害，但不适当的剂量遗漏与住院时间延长、败血症风险和死亡率增加有关。本研究旨在全面描述在使用电子药物管理系统的机构中，总体遗漏剂量和高风险药物剂量遗漏的发生率和性质。
本研究为澳大利亚三级转诊医疗服务机构的回顾性横断面研究。纳入 2014 年 7 月 1 日至 2015 年 6 月 30 日期间所有常规记录的电子住院剂量管理记录。确定了总体遗漏剂量和高风险药物遗漏剂量的发生率和特点。
在研究期间，共计划了 330 万次住院剂量，“未给予”的剂量占所有计划剂量的 6.2%。非有效剂量遗漏（药物不可用或未记录合理理由）占计划剂量的 1.2%。患者拒绝占所有剂量遗漏的三分之一，而 12%的剂量遗漏未提供任何解释，7%的剂量遗漏为“药物不可用”。高风险药物占所有剂量遗漏的 20%。计划的抗菌药物剂量中有 1/20 被遗漏，其中 17%是由于患者拒绝。
在这项大型研究中，电子药物管理系统实施后，剂量遗漏的时期发生率与使用纸质图表时发现的相似。尽管大多数剂量遗漏似乎是合理的，但由于患者拒绝或没有记录合理的理由，许多医嘱未执行。需要采取干预措施来尽量减少非故意的剂量遗漏。
