Department of Clinical Pharmacy, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, 201102, China.
School of Pharmacy, Fudan University, Shanghai, 201203, China.
Paediatr Drugs. 2022 Sep;24(5):555-562. doi: 10.1007/s40272-022-00521-2. Epub 2022 Jul 30.
Medication errors can happen at any phase of the medication process at health care settings. The objective of this study is to identify the characteristics of severe prescribing errors at a pediatric hospital in the inpatient setting and to provide recommendations to improve medication safety and rational drug use.
This descriptive retrospective study was conducted at a tertiary pediatric hospital using data collected from Jan. 1st, 2019 to Dec. 31st, 2020. During this period, the Prescription Pre-audit Intelligent Decision System was implemented. Medication orders with potential severe errors would trigger a Level 7 alert and would be intercepted before it reached the pharmacy. Trained pharmacists maintained the system and facilitated decision making when necessary. For each order intercepted by the system the following patient details were recorded and analyzed: patient age, patient's department, drug classification, dosage forms, route of administration, and the type of error.
A total of 2176 Level 7 medication orders were intercepted. The most common errors were associated with drug dosage, administration route, and dose frequency, accounting for 35.2%, 32.8% and 13.2%, respectively. Of all the intercepted oerrors. 53.6% occurred in infants aged < 1 year. Administration routes involved were mainly intravenous, oral and external use drugs. Most alerts came from the neonatology department and constituted 40.5% of the total alerts, followed by the nephrology department 15.9% and pediatric intensive care unit (PICU) 11.3%. As to dosage forms, injections accounted for 50.4% of alerts, with 21.3% attributable to topical solutions, 9.1% to tablets, and 5.7% to inhalation. Anti-infective agents were the most common therapeutic drugs prescribed with errors.
The Prescription Pre-audit Intelligent Decision System, with the supervision of trained pharmacists can validate prescriptions, increase prescription accuracy, and improve drug safety for hospitalized children. It is a medical service model worthy of consideration.
药物错误可能发生在医疗保健环境中药物治疗过程的任何阶段。本研究的目的是确定住院患儿严重处方错误的特征，并提供改善用药安全性和合理用药的建议。
本描述性回顾性研究在一家三级儿科医院进行，使用 2019 年 1 月 1 日至 2020 年 12 月 31 日期间收集的数据。在此期间，实施了处方预审核智能决策系统。有潜在严重错误的药物医嘱会触发 7 级警报，并在到达药房之前进行拦截。经过培训的药剂师维护该系统，并在必要时协助决策。对于系统拦截的每个医嘱，记录并分析以下患者详细信息：患者年龄、患者科室、药物分类、剂型、给药途径和错误类型。
共拦截了 2176 个 7 级药物医嘱。最常见的错误与药物剂量、给药途径和给药频率有关，分别占 35.2%、32.8%和 13.2%。在所有拦截的错误中，53.6%发生在<1 岁的婴儿中。涉及的给药途径主要是静脉内、口服和外用药物。大多数警报来自新生儿科，占总警报的 40.5%，其次是肾病科 15.9%和儿科重症监护病房（PICU）11.3%。就剂型而言，注射剂占警报的 50.4%，其中 21.3%归因于局部溶液，9.1%归因于片剂，5.7%归因于吸入剂。抗感染药物是最常见的开具错误的治疗药物。
处方预审核智能决策系统，在经过培训的药剂师的监督下，可以验证处方，提高处方准确性，提高住院儿童的药物安全性。这是一种值得考虑的医疗服务模式。
