我院门诊药房用药差错的原因分析与防范

目的分析医院药房用药差错的具体情况,为进一步规范医院药房管理提供借鉴。方法结合我院药师工作中的实例,分析药房用药差错的原因,提出防止用药差错的措施及对策。结果与结论个人因素与管理体系的漏洞导致了差错的产生,应加强个人素质的培养,加大管理力度,完善用药差错控制管理办法,提高医院整体用药水平。     

静脉用药调配中心用药错误分析及防范策略探讨

目的分析静脉用药调配中心用药错误( medication error,ME)的发生情况及特点,提出防范用药错误、保障病人用药安全的策略。方法统计 2018年 1月至 2020年 10月淮南朝阳医院静脉用药调配中心发生的 ME,采用回顾性分析和描述性统计方法,分析 ME的分级、错误内容、引发因素、引发人员、发现人员以及错误涉及药物等。结果共收集到 690例 ME,除 2例为 C级 ME外,其余 688例均为 B级 ME。ME的错误内容中,处方错误发生率最高,其次为核对错误和摆药错误。 ME的引发因素中,以知识欠缺、培训不足和责任心不足为主。 ME的引发人员以医师为主。 ME处方错误中涉及药物以抗微生物类药物、心血管系统药物和消化系统药物为主,这三类药 ME的发生各有其特点; ME处方错误中部分药物呈现错误形式单一的情况。结论该院应加强医师的专业技能培训,静配中心药师医嘱审核应重点关注药物浓度、溶媒和用量,静配中心工作人员责任心亟需加强,应构建精细化、信息化安全用药管理体系,以减少 ME的发生,保障病人安全用药。     

住院药房自动化单剂量摆药条件下的药疗差错防范

目的有效提高住院患者口服用药的安全性,降低药疗差错风险。方法用Excel表统计和分析我院住院药房2012年7月-12月发生的单剂量口服缺陷医嘱1 696例次。结果缺陷医嘱影响摆药机效率（剂量/单位错误、规格/厂家错误、执行时间与频率次数错误）979例次（57.7%）,影响用药安全（医嘱重复、用法用量不正确）717例次（42.3%）。结论采用医嘱单核对分包药品是发现药疗医嘱缺陷不可缺少的环节。通过增强岗位技能培训提高医务人员的审核能力、加强医药护沟通和强化电脑程序可减少缺陷医嘱和不合理用药医嘱数量,是预防药疗差错、提高单剂量口服用药安全性的有效手段。     

基于非惩罚制度下989例用药错误事件回顾性分析与风险防范

目的：通过回顾性分析989例用药错误（medication error，简称ME）事件，明确用药错误的环节并提出针对性改进措施，为保障患者用药安全提供依据。方法：采用回顾性分析法对989例ME不良事件进行统计分析，包括ME分级、分类、错误环节、发生原因、事件责任主体及上报人员分布情况。结果：ME分级中，B级ME发生率最高占60.77%；ME主要发生在处方开具与转录环节占68.35%，其次是给药监测环节占22.14%；ME分类中用药剂量错误，用药途径错误，遗漏用药，用药频次错误，混淆药品错误居前五位，占比依次为23.96%，15.17%，14.36%，9.50%，6.88%；医护人员用药知识技能培训不足是导致ME的主要原因；ME的责任主体以医师为主占62.90%，其次是护士占30.03%；ME主要是由药师上报占64.71%。结论：医师处方错误是造成ME的首要原因，药师参与是保障用药安全的关键，提高医护人员的整体风险意识水平和综合素质是减少ME的重要途径，医院应进一步加强用药安全信息化建设及用药安全培训以保障患者用药安全。     

Avoiding Potential Medication Errors Associated with Non-intuitive Medication Abbreviations

Background:

Pharmaceutical companies use a variety of abbreviations to denote short- and long-acting medications. Errors involving the administration of these medications are frequently reported.

Objectives:

To evaluate comprehension rates for abbreviations used to denote short- and long-acting medications and to evaluate whether changes to medication labels could reduce potential errors in the selection and administration of medications.

Methods:

In phase 1 of the study, nursing staff were asked to define 4 abbreviations and then to categorize them by release rate. In phase 2, a simulation exercise, nursing staff were asked if it would be appropriate to administer a medication illustrated in a photograph (oxycodone CR 5-mg blister pack) on the basis of information highlighted in a screen shot of an electronic medication administration record (order for oxycodone 5 mg). Three different presentations were used to identify the medication in the medication administration record and on the drug label.

Results:

In phase 1, 10 (28%) of 36 nursing staff members knew what all 4 abbreviations meant, and 14 (39%) correctly classified all 4 abbreviations as indicating a short- or a long-acting medication. In the simulation exercise (phase 2), labelling changes reduced the likelihood of a potential medication administration error.

Conclusions:

Most abbreviations used to indicate short- versus long-acting medications were not correctly understood by study participants. Of more concern was the incorrect interpretation of some abbreviations as indicating the opposite release rate (e.g., “ER” interpreted as meaning “emergency release”, rather than “extended release”, with incorrect classification as a short-acting medication). This evaluation highlighted the potential consequences of using non-intuitive abbreviations to differentiate high-risk medications having different release rates.     

Provision of medication therapy management to university faculty and staff members by third-year pharmacy students

Objective

To develop and implement a medication therapy management (MTM) curriculum and assess students'' skills and attitudes after the provision of MTM services to faculty and staff members.

Design

Third-year students enrolled in a pharmaceutical care laboratory course received lectures and participated in MTM activities in preparation for an MTM encounter. Students conduced MTM sessions with university faculty and staff members, providing comprehensive medication review, blood pressure checks, and optional blood glucose and cholesterol (total cholesterol and HDL) screenings.

Assessment

A faculty-developed rubric was used to evaluate students'' ability to explain MTM to the participant and address medication-related problems. Students'' responses on pre- and post-encounter survey instruments showed their confidence to provide MTM services, communicate with participants and other health care providers, and provide point-of-care screening services had increased.

Conclusion

Incorporating MTM into an existing laboratory course increased students'' confidence and perceived ability to provide MTM services.     

我院儿科门诊处方用药分析

目的 了解儿科门诊用药情况,分析存在的问题,促进合理用药.方法 随机抽取2010年1月～12月全年处方共计1 200张.统计每张处方用药品种数、基本药物使用率、含注射剂处方所占百分率、抗菌药物使用处方百分率、抗菌药物与中药注射剂联用处方所占的百分率,结合有关规定进行讨论分析.结果 注射剂应用百分率为45.0％,每张处方平均用药品种数为3.12种,使用抗菌药物的处方百分率为55.0％,抗菌药物与中药注射剂联合应用的百分率为23.0％,基本药物使用率为36.5％.结论 制定干预措施,加强政策宣传,切实做到临床用药安全、有效、经济.     

药物整合在呼吸内科患者用药差错防范中的应用

目的：探讨开展药物整合服务在促进合理用药、防范呼吸内科患者用药差错及风险中的作用。方法：临床药师通过回顾性病历调查分析,收集患者既往用药史、整理入院药物治疗医嘱清单,对2014年12月-2015年9月收住呼吸内科的95例患者进行药物整合,并探查临床用药中不合理问题及存在的风险。结果：临床药师问诊针对用药品种、用法用量及不良反应方面更详细;通过药物整合,发现不合理用药及风险共109例次,重复用药占42.20%,药物遗漏占11.01%,药物使用无指征占8.26%,不良相互作用占8.26%;针对药师发现的问题,87.16%被医师采纳并调整给药。结论：药物整合对促进合理用药、防范用药差错及风险具有重要的作用,为临床药师开展药学服务提供了一种新的方式。     

7638张急诊处方用药情况分析

目的:调查医院急诊用药情况,促进临床合理用药。方法:抽取2006年1~6月急诊药房处方7 638张,对有关临床抗菌药应用情况进行统计分析。结果:应用抗菌药的处方占总处方数的56.80%,抗菌药单用的处方占总抗菌药处方数的68.52%,二联及三联以上处方占31.48%。以销售金额计,β-内酰胺类占58.22%,氟喹诺酮类占20.87%,大环内酯类占9.63%,克林霉素占5.75%,氨基苷类占4.49%,其他类占1.04%。结论:β-内酰胺类抗生素和氟喹诺酮类临床应用最为广泛,我院抗菌药的应用仍存在问题。     

我院骨科门诊6272张处方评价及用药分析

目的 了解医院骨科门诊处方质量和用药情况,以促进合理用药.方法 以国家相关法律法规及药品说明书等为依据,对2011年2季度每月10个工作日抽取的骨科门诊6272张处方,进行用药合理性分析.结果 不合理处方3374张,不合理项目数3892处,主要为书写不规范及用药不合理.书写不规范处方主要表现为药品规格、单位书写不规范,用药不合理处方主要表现为用药疗程过长.结论 要减少不合理处方,需要医院所有医护人员共同努力,提高合理用药水平.     

FDA对处方药容器标签和纸盒标识的要求

美国食品和药品管理局(FDA)于2013年4月发布了"为把用药错误降到最低,容器标签和纸盒标识设计考虑的安全性问题"的指导原则(草案)。针对处方药提出了一整套建议,包括一般原则和具体的建议。我国尚无这类指导原则。综述了FDA该指导原则的内容,期望有利于提高我国药品标签和标识的质量并增强其监管工作,有益于确保用药者的安全。     

Comparison of women pharmacy and nursing students

The increasing number of women in pharmacy schools has had an impact on pharmacy manpower estimates. The nursing shortage has been used as an example of what may happen when women health professionals choose not to practice in their field. The purpose of this study was to determine whether the women students in these two health professions were similar with respect to demographics, career choice, career plans, and career commitment. A survey was distributed to undergraduate pharmacy students and baccalaureate nursing students at the University of Texas. The 168 women pharmacy students and 67 nursing students responding to the survey were included in the analyses. On average, the pharmacy students were younger, were more likely to be single, and had fathers of a higher socioeconomic status. When asked to indicate their primary reason for choosing their profession, the pharmacy students most often chose "want a career in the health field," whereas the nursing students chose "desire to help people" most often. When future plans of the two groups were compared, a higher percentage of the pharmacy students planned to work full time for the majority of their careers. Responses to Blau's Career Commitment Scale indicated that the women pharmacy students were more committed to their profession than were women nursing students. Although some may assume these groups are similar, results indicate that there are significant differences between them. Comparison of manpower issues between the two groups may not be justified.     

What is the scale of prescribing errors committed by junior doctors? A systematic review

AIMS

Prescribing errors are an important cause of patient safety incidents, generally considered to be made more frequently by junior doctors, but prevalence and causality are unclear. In order to inform the design of an educational intervention, a systematic review of the literature on prescribing errors made by junior doctors was undertaken.

METHODS

Searches were undertaken using the following databases: MEDLINE; EMBASE; Science and Social Sciences Citation Index; CINAHL; Health Management Information Consortium; PsychINFO; ISI Proceedings; The Proceedings of the British Pharmacological Society; Cochrane Library; National Research Register; Current Controlled Trials; and Index to Theses. Studies were selected if they reported prescribing errors committed by junior doctors in primary or secondary care, were in English, published since 1990 and undertaken in Western Europe, North America or Australasia.

RESULTS

Twenty-four studies meeting the inclusion criteria were identified. The range of error rates was 2–514 per 1000 items prescribed and 4.2–82% of patients or charts reviewed. Considerable variation was seen in design, methods, error definitions and error rates reported.

CONCLUSIONS

The review reveals a widespread problem that does not appear to be associated with different training models, healthcare systems or infrastructure. There was a range of designs, methods, error definitions and error rates, making meaningful conclusions difficult. No definitive study of prescribing errors has yet been conducted, and is urgently needed to provide reliable baseline data for interventions aimed at reducing errors. It is vital that future research is well constructed and generalizable using standard definitions and methods.