From the College of Pharmacy.
Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC.
Pediatr Emerg Care. 2022 Jan 1;38(1):e387-e392. doi: 10.1097/PEC.0000000000002296.
The pediatric emergency department (PED) is an especially high-risk setting for medication errors. Several factors contribute to this risk including the need to provide care to complex patients who are unknown to staff, the frequent use of verbal orders, and the necessity of weight-based dosing. This investigation sought to assess one potentially error-prone event, antibiotic prescriptions written for patients being discharged from the PED, and to characterize the occurrence of medication errors to identify opportunities for improvement.
This was a retrospective study of pediatric patients seen at a large academic medical center PED. All prescriptions written for an antibiotic for patients 18 years or younger that were discharged from the PED from 2015 to 2018 were evaluated for errors in directions, indication, dose, quantity, and refills. Because antibiotic dosing can vary based on indications, only disease states with guideline-specific dosing recommendations were evaluated for dosing errors.
A total of 11,815 antibiotic prescriptions were analyzed for patients discharged from the PED, and 1986 (16.8%) errors were identified. Of all the prescriptions reviewed, 517 (4.4%) contained an incomplete prescription error. Discharge prescriptions written by off-service physicians were more likely to contain incomplete prescription errors (5.1%) when compared with emergency medicine physicians (3.9%; P = 0.022). A dosing error rate of 18.5% (1469 prescriptions) was identified for the 7930 disease state-specific prescriptions reviewed. Underdosing errors were significantly more common (51.6%) than overdosing errors (29.3%; P < 0.0001). Among the different agents, there was noted to be a significant difference in the antibiotics most commonly involved in dosing errors (P < 0.0001). Additionally, there was also a significant difference in the incidence of dosing errors between different disease states (P < 0.0001). No significant difference was found in the incidence of dosing errors across physician specialties (P = 0.872).
We identified 1986 (16.8%) total errors in this analysis of antibiotic prescriptions written on discharge from the PED. Among the disease states evaluated, dosing errors were identified in 18.5% of prescriptions with the most common error being underdosing. Literature evaluating pediatric prescription errors, and specifically antibiotic discharge prescriptions, is quite limited. Further investigation is necessary in this area, and strategies should be developed leveraging technology, enhancing education, and using pharmacy personnel to help reduce antibiotic prescribing errors for patients discharged from the PED.
儿科急诊部（PED）是药物错误的高风险场所。导致这种风险的因素包括需要为员工不熟悉的复杂患者提供护理、经常使用口头医嘱以及基于体重给药的必要性。本研究旨在评估一个潜在易出错的事件，即开具给从 PED 出院的患者的抗生素处方，并描述药物错误的发生情况，以确定改进的机会。
这是对一家大型学术医疗中心 PED 就诊的 18 岁及以下患者进行的回顾性研究。评估了从 2015 年至 2018 年从 PED 出院的所有患者开具的抗生素处方，以评估用药方向、适应证、剂量、数量和续方的错误。由于抗生素的剂量可能因适应证而异，因此仅评估了具有特定指南剂量推荐的疾病状态的剂量错误。
共分析了 11815 名从 PED 出院的患者的抗生素处方，发现 1986 例（16.8%）错误。在所审查的所有处方中，517 份（4.4%）含有不完整处方错误。与急诊医师相比，非服务科室医师开具的出院处方更有可能出现不完整处方错误（5.1%；P=0.022）。在审查的 7930 种疾病状态特定处方中，发现剂量错误率为 18.5%（1469 份处方）。与剂量过大错误（29.3%；P<0.0001）相比，剂量不足错误更为常见（51.6%）。在不同的药物中，注意到最常涉及剂量错误的抗生素有显著差异（P<0.0001）。此外，不同疾病状态之间的剂量错误发生率也有显著差异（P<0.0001）。在医师专业之间，剂量错误发生率没有差异（P=0.872）。
在这项对从 PED 出院患者开具的抗生素处方的分析中，我们发现了 1986 例（16.8%）总错误。在所评估的疾病状态中，18.5%的处方存在剂量错误，最常见的错误是剂量不足。评估儿科处方错误，特别是抗生素出院处方的文献非常有限。在这一领域需要进一步调查，并应制定策略，利用技术、加强教育和使用药剂师人员，以减少从 PED 出院的患者的抗生素处方错误。
