Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria.
Evidence in Practice Unit, Mater Misericordiae Limited and Queensland Centre for Evidence-Based Nursing and Midwifery: A Joanna Briggs Institute Centre of Excellence, Brisbane, Queensland, Australia.
Int J Evid Based Healthc. 2020 Jun;18(2):188-211. doi: 10.1097/XEB.0000000000000232.
Medication errors are one of the leading avoidable sources of harm to hospital patients. In hospitals, a range of interventions have been used to reduce the risk of errors at each of the points they may occur, such as prescription, dispensing and/or administration. Systematic reviews have been conducted on many of these interventions; however, it is difficult to compare the clinical utility of any of the separate interventions without the use of a rigorous umbrella review methodology.
The aim of this umbrella review was to synthesize the evidence from all systematic reviews investigating the effectiveness of medication safety interventions, in comparison to any or no comparator, for preventing medication errors, medication-related harms and death in acute care patients.
The review considered quantitative systematic reviews with participants who were healthcare workers involved in prescribing, dispensing or administering medications. These healthcare workers were registered nurses, enrolled or licensed vocational nurses, midwives, pharmacists or medical doctors. Interventions of interest were those designed to prevent medication error in acute care settings. Eligible systematic reviews reported medication errors, medication-related harms and medication-related death as measured by error rates, numbers of adverse events and numbers of medication-related deaths. To qualify for inclusion, systematic reviews needed to provide a clearly articulated and comprehensive search strategy, and evidence of critical appraisal of the included studies using a standardized tool. Systematic reviews published in English since 2007 were included until present (March 2020). We searched a range of databases such MEDLINE, CINAHL, Web of Science, EMBASE, and The Cochrane Library for potentially eligible reviews. Identified citations were screened by two reviewers working independently. Potentially eligible articles were retrieved and assessed against the inclusion criteria and those meeting the criteria were then critically appraised using the JBI SUMARI instrument for assessing the methodological quality of systematic reviews and research syntheses. A predetermined quality threshold was used to exclude studies based on their reported methods. Following critical appraisal, data were extracted from the included studies by two independent reviewers using the relevant instrument in JBI SUMARI. Extracted findings were synthesized narratively and presented in tables to illustrate the reported outcomes for each intervention. The strength of the evidence for each intervention was indicated using 'traffic light' colors: green for effective interventions, amber for interventions with no evidence of an effect and red for interventions less effective than the comparison.
A total of 23 systematic reviews were included in this umbrella review. Most reviews did not report the number of participants in their included studies. Interventions targeted pharmacists, medical doctors, medical students and nurses, or were nonspecific about the participants. The majority of included reviews examined single interventions. All reviews were published and in English. Four interventions, medication administration education, medication reconciliation or review, specialist pharmacists' roles and physical or design modifications, reported effectiveness in reducing errors; however, heterogeneity between the included studies in these reviews was high.
For some interventions, there are strong indications of effectiveness in reducing medication errors in the inpatient setting. Government initiatives, policy makers and practitioners interested in improving medication safety are encouraged to adopt those interventions.
药物错误是导致医院患者伤害的主要可避免原因之一。在医院中，已经采用了一系列干预措施来降低每个可能发生错误的点的风险，例如处方、配药和/或给药。已经对许多这些干预措施进行了系统评价；然而，如果不使用严格的伞式审查方法，就很难比较任何单独干预措施的临床效果。
本伞式审查旨在综合所有系统评价的证据，这些系统评价调查了药物安全干预措施的有效性，与任何或没有比较药物相比，用于预防急性护理患者的药物错误、药物相关伤害和死亡。
该综述考虑了参与者为参与处方、配药或给药的医疗保健工作者的定量系统评价。这些医疗保健工作者是注册护士、注册或持牌职业护士、助产士、药剂师或医生。感兴趣的干预措施旨在预防急性护理环境中的药物错误。合格的系统评价报告了药物错误、药物相关伤害和药物相关死亡，以错误率、不良事件数量和药物相关死亡数量来衡量。为了符合纳入标准，系统评价需要提供明确阐述和全面的搜索策略，并使用标准化工具证明对纳入研究的批判性评估。自 2007 年以来以英文发表的系统评价都被包括在内，直到现在（2020 年 3 月）。我们在 MEDLINE、CINAHL、Web of Science、EMBASE 和 The Cochrane Library 等多种数据库中搜索了可能符合条件的综述。由两名独立评审员筛选识别出的引文。检索出可能符合条件的文章，并根据纳入标准进行评估，然后使用 JBI SUMARI 工具对符合标准的文章进行批判性评估，以评估系统评价和研究综合的方法学质量。使用预定的质量阈值根据报告的方法排除研究。经过批判性评估后，两名独立评审员使用 JBI SUMARI 中的相关工具从纳入的研究中提取数据。提取的结果以叙述的方式进行综合，并以表格形式呈现，以说明每个干预措施的报告结果。每个干预措施的证据强度用“交通灯”颜色表示：绿色表示有效干预措施，琥珀色表示无效果干预措施，红色表示效果不如对照措施。
本伞式审查共纳入 23 项系统评价。大多数综述没有报告其纳入研究的参与者人数。干预措施针对药剂师、医生、医学生和护士，或者没有说明参与者。大多数纳入的综述都检查了单一的干预措施。所有综述均为已发表的英文文献。四项干预措施，即药物管理教育、药物重整或审查、专科药剂师的角色以及物理或设计修改，报告了减少错误的有效性；然而，这些综述中的纳入研究之间存在高度异质性。
对于某些干预措施，在减少住院患者药物错误方面有很强的有效性迹象。鼓励政府倡议、政策制定者和有兴趣改善药物安全性的从业者采用这些干预措施。
