Canales-Siguero M D, García-Muñoz C, Caro-Teller J M, Piris-Borregas S, Martín-Aragón S, Ferrari-Piquero J M, Moral-Pumarega M T, Pallás-Alonso C R
Departament of Pharmacy, 12 de Octubre University Hospital, Madrid, Spain.
i+12 Research Institute, Madrid, Spain.
J Med Syst. 2025 Feb 18;49(1):26. doi: 10.1007/s10916-025-02161-8.
Patients admitted to neonatal intensive care units are up to eight times more likely to experience medication errors than patients admitted to adult intensive care units. Prescribing errors account for up to 74% of medication errors. Electronic prescribing has been postulated as a tool to reduce errors. The objective was to analyse prescribing errors with the e-prescribing system and risk factors. All patients who were admitted for at least 24 h and who received active pharmacological treatment during the study period were included. Prescriptions were made using electronic assisted prescription software integrated into the medical record system. Treatment was reviewed daily by a pharmacist, and errors were graded according to taxonomic criteria. A total of 240 patients were included, 13,876 prescriptions were reviewed and 455 errors were found (3.3% of prescriptions were wrong). Prescribing errors were concentrated in 40 drugs/nutritional products. The most frequent error was a discrepancy between the prescription and the associated text-free field (n = 196). The drugs with the most errors were Lactobacillus acidophilus, caffeine citrate, acetaminophen, gentamycin and cholecalciferol. Patients with a birth weight from 1000 to 1500 g were 82% more likely to experience an error than those with an extremely low birth weight (< 1000 g) (OR = 1.81, 95% CI = 1.42-2.89, p < 0.05). Patients at the highest risk were those with gestational ages from 28 to 32 weeks, with a 29.80% greater risk of prescribing errors than those with gestational ages less than 28 weeks (OR = 1.29, 95% CI = 1.02-1.65, p < 0.05). Prescribing errors occur due to complex dosing rules based on patient characteristics and free-text use, highlighting process issues rather than specific medication risks.
入住新生儿重症监护病房的患者发生用药错误的可能性是入住成人重症监护病房患者的八倍。处方错误占用药错误的比例高达74%。电子处方被认为是一种减少错误的工具。目的是分析电子处方系统中的处方错误及风险因素。纳入所有在研究期间住院至少24小时且接受积极药物治疗的患者。使用集成到病历系统中的电子辅助处方软件开具处方。药剂师每天对治疗进行审查，并根据分类标准对错误进行分级。共纳入240例患者，审查了13876张处方，发现455处错误（占处方的3.3%）。处方错误集中在40种药物/营养产品上。最常见的错误是处方与相关无文本字段之间存在差异（n = 196）。错误最多的药物是嗜酸乳杆菌、枸橼酸咖啡因、对乙酰氨基酚、庆大霉素和胆钙化醇。出生体重在1000至1500克之间的患者发生错误的可能性比极低出生体重（<1000克）的患者高82%（OR = 1.81，95%CI = 1.42 - 2.89，p < 0.05）。风险最高的患者是胎龄为28至32周的患者，其发生处方错误的风险比胎龄小于28周的患者高29.80%（OR = 1.29，95%CI = 1.02 - 1.65，p < 0.05）。由于基于患者特征的复杂给药规则和自由文本使用导致处方错误，突出了流程问题而非特定的用药风险。
