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临床领域护士静脉药物配制技术培训项目

Intravenous medicine preparation technique training programme for nurses in clinical areas.

作者信息

Campino Ainara, Sordo Beatriz, Pascual PIlar, Arranz Casilda, Santesteban Elena, Unceta Maria, Lopez-de-Heredia Ion

机构信息

Hospital Pharmacy, Cruces University Hospital, Barakaldo, Spain.

Neonatal Intensive Care Unit, Department of Pediatrics, Cruces University Hospital, Barakaldo, Spain.

出版信息

Eur J Hosp Pharm. 2018 Nov;25(6):298-300. doi: 10.1136/ejhpharm-2016-000947. Epub 2017 Jun 6.

Abstract

OBJECTIVE

The key objective of this study was to highlight the weak points in the medicine use process.

METHOD

We collected 15 videos from eight neonatal intensive care units where staff nurses showed how medicine preparation was performed. Recorded medicines were: vancomycin (6), gentamicin (5), caffeine citrate (2) and phenobarbital (2).

RESULTS

We did not review any video without errors. In 8/15 (53.3%) videos, the same syringe was used to measure the medicine and the diluent. In 8/15 (53.3%) videos, the syringes used were not the correct size for the volume being measured. In 4/15 (26.6%) videos, the volume measured into the syringes was not checked after it was measured from vials or ampoules. In just one vancomycin preparation could the reconstitution process be described as a correct process; in the other five videos, mixing after diluent addition to the vancomycin vial was almost non-existent (less than 10 s). Mixing after the medicine and diluent were in the same syringe was also non-existent in all of the videos.

CONCLUSIONS

Hospitals should provide training programmes outlining the correct preparation technique.

摘要

目的

本研究的主要目的是突出用药过程中的薄弱环节。

方法

我们从八个新生儿重症监护病房收集了15个视频,其中护士展示了药品配制过程。记录的药品有:万古霉素(6次)、庆大霉素(5次)、枸橼酸咖啡因(2次)和苯巴比妥(2次)。

结果

我们审查的视频均有错误。在15个视频中的8个(53.3%)中,使用同一注射器来量取药品和稀释剂。在15个视频中的8个(53.3%)中,所用注射器的尺寸与所量取的体积不匹配。在15个视频中的4个(26.6%)中,从小瓶或安瓿中量取到注射器中的体积未进行检查。在万古霉素配制过程中,只有一次可被描述为正确过程;在其他五个视频中,向万古霉素小瓶中加入稀释剂后的混合操作几乎不存在(少于10秒)。在所有视频中,药品和稀释剂在同一注射器中后的混合操作也不存在。

结论

医院应提供概述正确配制技术的培训方案。

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本文引用的文献

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Incidents and errors in neonatal intensive care: a review of the literature.新生儿重症监护中的事件与差错:文献综述
Arch Dis Child Fetal Neonatal Ed. 2007 Sep;92(5):F391-8. doi: 10.1136/adc.2006.106419. Epub 2007 Mar 21.

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