Cohen M R, Anderson R W, Attilio R M, Green L, Muller R J, Pruemer J M
Institute for Safe Medication Practices, Warminster, PA 18974-3236, USA.
Am J Health Syst Pharm. 1996 Apr 1;53(7):737-46. doi: 10.1093/ajhp/53.7.737.
Recommendations for preventing medication errors in cancer chemotherapy are made. Before a health care provider is granted privileges to prescribe, dispense, or administer antineoplastic agents, he or she should undergo a tailored educational program and possibly testing or certification. Appropriate reference materials should be developed. Each institution should develop a dose-verification process with as many independent checks as possible. A detailed checklist covering prescribing, transcribing, dispensing, and administration should be used. Oral orders are not acceptable. All doses should be calculated independently by the physician, the pharmacist, and the nurse. Dosage limits should be established and a review process set up for doses that exceed the limits. These limits should be entered into pharmacy computer systems, listed on preprinted order forms, stated on the product packaging, placed in strategic locations in the institution, and communicated to employees. The prescribing vocabulary must be standardized. Acronyms, abbreviations, and brand names must be avoided and steps taken to avoid other sources of confusion in the written orders, such as trailing zeros. Preprinted antineoplastic drug order forms containing checklists can help avoid errors. Manufacturers should be encouraged to avoid or eliminate ambiguities in drug names and dosing information. Patients must be educated about all aspects of their cancer chemotherapy, as patients represent a last line of defense against errors. An interdisciplinary team at each practice site should review every medication error reported. Pharmacists should be involved at all sites where antineoplastic agents are dispensed. Although it may not be possible to eliminate all medication errors in cancer chemotherapy, the risk can be minimized through specific steps. Because of their training and experience, pharmacists should take the lead in this effort.
提出了预防癌症化疗用药错误的建议。在医疗保健提供者被授予开具、调配或使用抗肿瘤药物的权限之前，他或她应参加量身定制的教育项目，并可能接受测试或认证。应编制适当的参考资料。每个机构都应制定一个尽可能多进行独立核对的剂量核实程序。应使用涵盖开具、转录、调配和使用的详细清单。口头医嘱是不可接受的。所有剂量都应由医生、药剂师和护士独立计算。应设定剂量限制，并为超过限制的剂量建立审核程序。这些限制应输入药房计算机系统，列在预先印好的医嘱单上，标明在产品包装上，放置在机构的关键位置，并传达给员工。开具处方的词汇必须标准化。必须避免使用首字母缩略词、缩写词和品牌名称，并采取措施避免书面医嘱中的其他混淆来源，如尾随零。包含清单的预先印好的抗肿瘤药物医嘱单有助于避免错误。应鼓励制造商避免或消除药品名称和给药信息中的歧义。必须对患者进行癌症化疗各方面的教育，因为患者是防止错误的最后一道防线。每个医疗机构的跨学科团队应审查报告的每一起用药错误。在调配抗肿瘤药物的所有地点都应配备药剂师。虽然可能无法消除癌症化疗中的所有用药错误，但通过具体措施可以将风险降至最低。由于药剂师的培训和经验，他们应在这项工作中发挥带头作用。
