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一款用于管理慢性病年轻患者居家安全的手机用药错误电子健康应用程序:一项前瞻性研究。

A Cell-Phone Medication Error eHealth App for Managing Safety in Chronically Ill Young Patients at Home: A Prospective Study.

作者信息

Tiozzo Emanuela, Rosati Paola, Brancaccio Matilde, Biagioli Valentina, Ricci Riccardo, d'Inzeo Victoria, Scarselletta Gianna, Piga Simone, Vanzi Valentina, Dall'Oglio Immacolata, Gawronski Orsola, Offidani Caterina, Pulimeno Maria Ausilia, Raponi Massimiliano

机构信息

Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

出版信息

Telemed J E Health. 2023 Apr;29(4):584-592. doi: 10.1089/tmj.2022.0042. Epub 2022 Sep 7.

Abstract

Whereas ample information describes medication errors (MEs) in children or in mixed pediatric and adult populations discharged with acute or chronic diseases from hospital to community settings, little is known about MEs in children and adolescents with chronic diseases discharged home, a major concern. To promote home medication safety, we trained parents of children discharged with chronic diseases to record ME with a tailored cell-phone eHealth app. In a 1-year prospective study, we used the app to monitor ME in patients with chronic diseases discharged home from a tertiary hospital in Rome, Italy. Univariate and multivariate analyses detected the ME incidence rate ratio (IRR). Of the 310 parents enrolled, 194 used the app. The 41 MEs involved all drug management phases. The ME IRR was 0.46 errors per child. Children <1 year had the highest ME risk (1.69 vs. 0.35,  = 0.002). Children discharged from the cardiology unit had a statistically higher ME IRR than others (3.66, 95% confidence interval: 1.01-13.23%). The highest ME risk at home involves children with chronic diseases <1 year old. A significant ME IRR at home concerns children with heart diseases of any age. Parents find a tailored eHealth app for monitoring and reporting ME at home easy to use. At discharge, clinical teams need to identify age-related and disease-residual risks to target additional actions for monitoring ME, thus increasing medication safety at home.

摘要

虽然有大量信息描述了患有急性或慢性疾病的儿童或儿童与成人混合群体从医院出院到社区环境中的用药错误(MEs),但对于患有慢性疾病的儿童和青少年出院回家后的用药错误却知之甚少,这是一个主要问题。为了促进家庭用药安全,我们培训了患有慢性疾病出院儿童的家长,让他们使用一款量身定制的手机电子健康应用程序记录用药错误。在一项为期1年的前瞻性研究中,我们使用该应用程序监测了从意大利罗马一家三级医院出院回家的慢性病患者的用药错误。单因素和多因素分析检测了用药错误发生率比(IRR)。在登记的310名家长中,194名使用了该应用程序。41起用药错误涉及所有药物管理阶段。用药错误IRR为每名儿童0.46起错误。1岁以下儿童的用药错误风险最高(1.69对0.35,P = 0.002)。从心脏病科出院的儿童的用药错误IRR在统计学上高于其他儿童(3.66,95%置信区间:1.01 - 13.23%)。在家中用药错误风险最高的是1岁以下患有慢性疾病的儿童。家中任何年龄患有心脏病的儿童都存在显著的用药错误IRR。家长们发现一款用于在家中监测和报告用药错误的量身定制的电子健康应用程序易于使用。在出院时,临床团队需要识别与年龄相关和疾病残留风险,以便针对监测用药错误采取额外行动,从而提高家庭用药安全性。

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