Robin Lebas , Benjamin Calvet , Laurence Schadler , Pierre-Marie Preux , Marie-Laure Laroche
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引用次数: 0
Abstract
Background
Particularities in psychiatry care can increase the risk of medication errors (MEs).
Objective
To analyze the MEs that occurred in a psychiatric hospital and to quantify relationships between the use of certain types of medication and the type of MEs.
Methods
We conducted a retrospective register based cross-sectional study in a French psychiatric hospital (2014–2021). All MEs were analyzed using ALARM method to identify type, stage of occurring and interception (defenses), consequences, drug involved and root causes. The prevalence-odds ratio (POR) was calculated to estimate relationships between five selected medication situations (long-acting injectable antipsychotics (LAIA), oral liquid dosage forms in a multiple-unit-container (OLDS-MC), psychotropic drugs (PD), controlled medicines (CM) or high-alert drugs) and the type of MEs occurred.
Results
Among the 609 MEs reported, wrong dose (32.2%), wrong drug (30.3%), omission (14.2%) and wrong patient (12.9%) were frequently observed. The ME occurrence stage were prescribing (55.3%) and administration (30.2%). Medication order review intercepted 77.9% of MEs. CM or LAIA increased the risk of medication omission (POR: 3.9, 95%CI: 1.8–8.4 and 2.5, 95%CI; 1.2–5.1, respectively) while the use of high-alert medications decreased it (0.2, 95%CI: 0.1–0.8). OLDS-MC and PD were more likely to be administered to the wrong patient (6.1, 95%CI: 3.3–11.4 and 16.1, 95%CI: 7.2–35.8). LAIA were associated with an increased risk of wrong dose (3.4, 95%CI: 1.8–6.3). Actual errors risk was lower with high-alert drugs (0.5, 95%CI: 0.3–09), but higher with CM (3.5, 95%CI: 1.5–8.0), OLDS-MC (2.1, 95%CI: 1.2–3.8) and PD (2.5, 95%CI: 1.8–3.5). Patients exposed to high-alert drugs were likely to have a serious error (3.5, 95%CI: 1.2–10.4).
Conclusions
This study sheds an innovative approach to analyze MEs by demonstrating that certain medication situations were more likely to lead to certain types of error. This enables the most appropriate prevention barriers to be put in place to intercept ME.
背景精神病护理中的特殊情况可能会增加用药错误(ME)的风险。目的分析一家精神病医院中发生的 ME,并量化特定类型药物的使用与 ME 类型之间的关系。我们采用ALARM方法对所有MEs进行了分析,以确定类型、发生和截获阶段(防御)、后果、涉及的药物和根本原因。通过计算流行率-比率(POR)来估算五种选定用药情况(长效注射用抗精神病药物(LAIA)、多单位容器口服液剂型(OLDS-MC)、精神药物(PD)、管制药品(CM)或高警戒药物)与ME发生类型之间的关系。结果在报告的 609 例 ME 中,错误剂量(32.2%)、错误药物(30.3%)、遗漏(14.2%)和错误病人(12.9%)是常见的问题。发生 ME 的阶段是开处方(55.3%)和给药(30.2%)。77.9% 的 "医嘱审查 "拦截了 "医嘱错误"。CM或LAIA增加了漏药风险(POR:3.9,95%CI:1.8-8.4和2.5,95%CI:1.2-5.1),而使用高警戒药物则降低了漏药风险(0.2,95%CI:0.1-0.8)。OLDS-MC和PD更有可能被用错药(6.1,95%CI:3.3-11.4和16.1,95%CI:7.2-35.8)。LAIA与剂量错误风险增加有关(3.4,95%CI:1.8-6.3)。高警戒药物的实际错误风险较低(0.5,95%CI:0.3-09),但CM(3.5,95%CI:1.5-8.0)、OLDS-MC(2.1,95%CI:1.2-3.8)和PD(2.5,95%CI:1.8-3.5)的实际错误风险较高。本研究通过证明某些用药情况更容易导致某些类型的错误,为分析 ME 提供了一种创新方法。因此,我们可以采取最适当的预防措施来阻止 ME 的发生。
期刊介绍:
Research in Social and Administrative Pharmacy (RSAP) is a quarterly publication featuring original scientific reports and comprehensive review articles in the social and administrative pharmaceutical sciences. Topics of interest include outcomes evaluation of products, programs, or services; pharmacoepidemiology; medication adherence; direct-to-consumer advertising of prescription medications; disease state management; health systems reform; drug marketing; medication distribution systems such as e-prescribing; web-based pharmaceutical/medical services; drug commerce and re-importation; and health professions workforce issues.