Jiménez Muñoz Ana Belén, Martínez Mondéjar Belén, Muiño Miguez Antonio, Romero Ayuso Dulce, Saiz Ladera Gema Maria, Criado Álvarez Juan José
Servicio de Medicina Preventiva. Hospital Universitario Severo Ochoa. Leganés. Madrid. España.
Servicio de Medicina Interna. Hospital General Universitario Gregorio Marañón. Madrid. España.
Rev Esp Salud Publica. 2019 Jan 31;93:e201901004.
Most studies of medication errors are focused only on finding global prevalence by patients, by phases or according to a certain group of medication. It's just a partial view of the problem. To analyze and compare the prevalence of errors in prescription, transcription and administration, and their clinical repercussions in different pharmacological groups in a third-level hospital.
Prospective inclusion study with direct observation disguised as medication administration and comparison with prescriptions and transcriptions at history clinical. The ME and its clinical effects were classified by expert consensus. We calculated the different error rates and their repercussions with their confidence intervals at 95%. Then we compared using Chi-square tests.
We studied 5,578 prescribed drugs and we observed the administration of 1,879 doses. A total of 117 different pharmacological groups were found, although 50.1% of the prescriptions belonged to only 9 types. We found heparins had a lower prevalence of errors in prescription and transcription and aspirin also had a lower prevalence of prescription errors. On the opposite side, a greater number of errors were obtained in transcription of Paracetamol, Metamizole and Laxatives and a prevalence of errors in the administration phase superior to rest in Paracetamol and in Proton Pump Inhibitors. The impact of medication error increased as medication process progressed, being similar between groups in prescription. In transcription, Heparins and Corticosteroids presented more serious errors. In administration, medication error are more serious for Diuretics and Statins (p <0.05).
Drugs considered potentially dangerous present fewer errors (Heparins, Corticoids), but more serious. Drugs with the highest prevalence of errors were Paracetamol and Inhibitors of proton pump but had a lower impact.
大多数关于用药错误的研究仅专注于通过患者、阶段或根据某类药物来找出总体发生率。这只是对该问题的部分看法。分析并比较三级医院中不同药理学组在处方、转录和给药过程中的错误发生率及其临床影响。
采用前瞻性纳入研究，通过伪装成给药过程进行直接观察，并与临床病历中的处方和转录内容进行比较。用药错误及其临床影响由专家共识进行分类。我们计算了不同的错误率及其95%置信区间的影响。然后使用卡方检验进行比较。
我们研究了5578种处方药，并观察了1879剂药物的给药情况。共发现117个不同的药理学组，尽管50.1%的处方仅属于9种类型。我们发现肝素在处方和转录中的错误发生率较低，阿司匹林在处方中的错误发生率也较低。相反，对乙酰氨基酚、安乃近和泻药的转录错误较多，对乙酰氨基酚和质子泵抑制剂在给药阶段的错误发生率高于其他药物。用药错误的影响随着用药过程的推进而增加，在处方方面各药物组之间相似。在转录方面，肝素和皮质类固醇出现的错误更严重。在给药方面，利尿剂和他汀类药物的用药错误更严重（p<0.05）。
被认为具有潜在危险性的药物错误较少（肝素、皮质类固醇），但后果更严重。错误发生率最高的药物是对乙酰氨基酚和质子泵抑制剂，但影响较小。
