横断面研究：巴基斯坦开伯尔-普赫图赫瓦省三级护理医院癌症住院患者的用药安全。
A cross-sectional study: medication safety among cancer in-patients in tertiary care hospitals in KPK, Pakistan.
机构信息
Quaid-I-Azam University, QAU Islamabad, Islamabad, Pakistan.
Department of Pharmacy, Qauid-I-Azam University, QAU Islamabad, Islamabad, Pakistan.
出版信息
BMC Health Serv Res. 2019 Aug 19;19(1):583. doi: 10.1186/s12913-019-4420-7.
BACKGROUND
Medication safety in cancer patients receiving complex medication regimens is an important problem in various settings. Medication related events, interceptions and interventions are not well described in this area. We intended to study incidence, types, settings and stages involved, root cause analysis, medication classes involved and the level of harm cause by medication errors in two hospitals providing oncology services comparatively. The severity of incidents and interventions are studied.
METHODS
It was a prospective cross sectional study among cancer in-patients of two tertiary care hospitals of KPK. Scale by NCC-MERP was used for evaluation of all medication related incidents. The data obtained was analyzed by IBM SPSS statistics 22 with 95% confidence interval and used the same for other descriptive statistics.
RESULTS
All medication orders were reviewed at both sites (Computerized Prescription Order Entry and HWP systems). Potential ADEs incidence was found high at site 2 (97.5%) while medication errors without harm was high at site 1 (97.5%). Most events occur at prescribing level 87.6 and 81.7% at both sites 1 and 2. Types highly reported involved improper dose 31.4 and 15.5%, monitoring error 14.6 and 15.2% at site 1 and 2. Medications involved in these incidents were antibiotics 44 and 12.7%, antiemetic 7.5 and 15.8% and antineoplastic 2.9 and 9.4% at site 1 and 2. Severity of 3.6 and 36.5% incidents had potential to cause harm at site 1 and 2. Root causes were human factors 62.6 and 72.3%, drug selection 33.6 and 38.8%, and dose selection 39.6 and 15.3% at sites 1 and 2. Contributing factors including staff training 33.6 and 24.3%, system for covering patient care 14.9 and 36.6%, communication system 2.4 and 20.3%, interruptions 9.7 and 7.3% and others 78.8 and 68.6% were highly reported. Preventability of medication errors was 99% at both sites. Intervention was taken in 90.5% events at site 1 (CPOE system) while the incidence lowest at site 2 (HWP system).
CONCLUSION
Medication related events are high among cancer in-patients at the site lacking updated electronic system for medication prescribing. Proper training about medication safety, reporting and interventions are required.
背景
在接受复杂药物治疗方案的癌症患者中，药物安全是各种环境中的一个重要问题。在该领域，药物相关事件、拦截和干预措施并未得到很好的描述。我们旨在研究两家提供肿瘤服务的医院中，药物错误导致的发生率、类型、发生地点和阶段、根本原因分析、涉及的药物类别以及对伤害程度的影响。研究了事件和干预措施的严重程度。
方法
这是在开伯尔-普赫图赫瓦省两家三级保健医院的癌症住院患者中进行的前瞻性横断面研究。使用 NCC-MERP 量表评估所有与药物相关的事件。使用 IBM SPSS 统计 22 获得的数据进行分析，置信区间为 95%，并用于其他描述性统计。
结果
对两个地点（计算机化处方输入系统和 HWP 系统）的所有药物医嘱进行了审查。发现第 2 个地点的潜在 ADE 发生率较高（97.5%），而第 1 个地点的无伤害性药物错误发生率较高（97.5%）。大多数事件发生在处方级别 87.6%，两个地点 1 和 2 均为 81.7%。报告的主要类型包括剂量不当 31.4%和 15.5%，监测错误 14.6%和 15.2%，地点 1 和 2。涉及这些事件的药物是抗生素 44%和 12.7%，止吐药 7.5%和 15.8%，抗肿瘤药 2.9%和 9.4%。地点 1 和 2 中 3.6%和 36.5%的事件严重程度有可能造成伤害。人为因素 62.6%和 72.3%、药物选择 33.6%和 38.8%以及剂量选择 39.6%和 15.3%是导致这两个地点发生问题的主要原因。促成因素包括员工培训 33.6%和 24.3%、覆盖患者护理的系统 14.9%和 36.6%、沟通系统 2.4%和 20.3%、中断 9.7%和 7.3%以及其他因素 78.8%和 68.6%。两个地点的药物错误可预防率均为 99%。地点 1（CPOE 系统）的干预发生率为 90.5%，而地点 2（HWP 系统）的发生率最低。
结论
在缺乏更新的药物处方电子系统的情况下，癌症住院患者的药物相关事件发生率较高。需要进行药物安全、报告和干预方面的适当培训。
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