Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia.
Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
Drug Saf. 2019 Nov;42(11):1329-1342. doi: 10.1007/s40264-019-00850-1.
The risk of medication errors is high in paediatric inpatient settings. However, estimates of the prevalence of medication errors have not accounted for heterogeneity across studies in error identification methods and definitions, nor contextual differences across wards and the use of electronic or paper medication charts.
Our aim was to conduct a systematic review and meta-analysis to provide separate estimates of the prevalence of medication errors among paediatric inpatients, depending on hospital ward and the use of electronic or paper medication charts, that address differences in error identification methods and definitions.
We systematically searched five databases to identify studies published between January 2000 and December 2018 that assessed medication error rates by medication chart audit, direct observation or a combination of methods.
We identified 71 studies, 19 involved paediatric wards using electronic charts. Most studies assessed prescribing errors with few studies assessing administration errors. Estimates varied by ward type. Studies of paediatric wards using electronic charts generally reported a reduced error prevalence compared to those using paper, although there were some inconsistencies. Error detection methods impacted the rate of administration errors in studies of multiple wards, however, no other difference was found. Definition of medication error did not have a consistent impact on reported error rates.
Medication errors are a frequent occurrence in paediatric inpatient settings, particularly in intensive care wards and emergency departments. Hospitals using electronic charts tended to have a lower rate of medication errors compared to those using paper charts. Future research employing controlled designs is needed to determine the true impact of electronic charts and other interventions on medication errors and associated harm among hospitalized children.
儿科住院环境中用药错误的风险很高。然而，用药错误的发生率估计并未考虑到错误识别方法和定义的研究内变异性，也未考虑到病房之间的差异以及电子或纸质用药图表的使用。
我们旨在进行系统评价和荟萃分析，根据医院病房和电子或纸质用药图表的使用情况，提供儿科住院患者用药错误发生率的单独估计值，这些估计值考虑了错误识别方法和定义的差异。
我们系统地搜索了五个数据库，以确定发表于 2000 年 1 月至 2018 年 12 月期间的评估用药错误率的研究，这些研究通过用药图表审核、直接观察或联合方法进行评估。
我们确定了 71 项研究，其中 19 项研究涉及使用电子图表的儿科病房。大多数研究评估了处方错误，很少有研究评估了给药错误。估计值因病房类型而异。使用电子图表的儿科病房的研究报告的错误发生率通常低于使用纸质图表的研究，尽管存在一些不一致之处。在多病房的研究中，错误检测方法对给药错误的发生率有影响，但没有发现其他差异。用药错误的定义对报告的错误率没有一致的影响。
用药错误在儿科住院环境中频繁发生，尤其是在重症监护病房和急诊科。与使用纸质图表的医院相比，使用电子图表的医院用药错误发生率较低。需要采用对照设计的未来研究来确定电子图表和其他干预措施对住院儿童用药错误及其相关危害的真正影响。
