瑞士一所儿科大学医院使用无证药品的情况及相关处方错误率--一项回顾性观察研究

IF 2.1 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Swiss medical weekly Pub Date : 2024-03-04 DOI:10.57187/s.3369

A. Satir, M. Pfiffner, Christoph R. Meier, A. Caduff Good

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引用次数: 0

摘要

研究目的：儿科护理中经常使用未经许可的药物。目前尚不清楚瑞士医院在多大程度上使用无证药品。由于处方错误似乎更频繁地发生在无证药物上，因此我们旨在评估苏黎世大学儿童医院在两个研究期间（2018 年和 2019 年）无证药物处方的发生率，对这两个期间进行比较，并调查无证药物是否比有证药物更容易发生处方错误。方法：我们对一项回顾性单中心观察研究进行了子分析，分析了 2018 年和 2019 年儿科普通病房共 1000 名患者的 5022 份处方。研究调查了无证药物（包括进口或配方药物）的使用率。对 2019 年的处方进行了进一步的处方错误分析，以了解是无证用药还是有证用药的错误发生率更高。结果：在所有处方中，10.8% 为无证用药，进口药和配方药各占一半左右。在所有患者中，34%的人至少被处方了一种无证药物。年龄较小的儿科病人比年龄较大的儿科病人（新生儿：15.8%的处方；婴儿：15.8%的处方）获得更多的无证药物处方：新生儿：占处方的 15.8%，婴儿：占处方的 13.4%，儿童：占处方的 10.4%：13.4%，儿童：10.6%，青少年：7.1%）：7.1%).布洛芬栓剂、咪达唑仑口服液和庆大霉素静脉注射液是最常处方的进口药物。麦考酚酚粉剂、利辛普利口服混悬液和氯化钾静脉注射液是最常处方的配方药物。最常见的无证使用药物是口服液和静脉注射溶液。无证药品的处方错误率明显高于有证药品（每 100 张处方中出现 31.6 次错误 [95% CI：26.1-37.0] 对每 100 张处方中出现 24.3 次错误 [95% CI：22.3-26.2]，p = 0.024）。尤其是配方药物的风险更高（每 100 张处方中出现 36.4 次错误，p = 0.012）：结论：在瑞士的儿科医院中，无证药物的处方很常见。大约每十张处方中就有一张是无证药品。由于无证药品的处方错误率明显较高，因此从用药安全角度考虑，应尽可能处方有证药品。如果没有特许药物，则应优先选择进口药物，而不是配方药物，因为进口药物的处方错误率较低。为了提高瑞士儿科的用药安全，有必要努力增加适合儿科患者的特许药物配方，包括开发新的儿童创新药物配方。

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Use of unlicensed drugs in a Swiss Pediatric University Hospital and associated prescribing error rates – a retrospective observational study

AIMS OF THE STUDY: Unlicensed drugs are frequently used in paediatric care. To what extent they are prescribed in hospital care in Switzerland is unclear. Because prescribing errors seem to occur more frequently with unlicensed drugs, we aimed to assess the prevalence of unlicensed drug prescriptions in two study periods (2018 and 2019) at the University Children’s Hospital Zurich, compare these periods and investigate whether unlicensed drugs were more prone to prescribing errors than licensed drugs. METHODS: We conducted a sub-analysis of a retrospective single-centre observational study and analysed 5,022 prescriptions for a total of 1,000 patients from 2018 and 2019 in paediatric general wards. The rate of unlicensed drugs, consisting of imported or formula drugs, was investigated. The prescriptions from 2019 were further analysed on prescribing errors to see whether errors occurred more often in unlicensed or licensed drug use. RESULTS: Of all prescriptions, 10.8% were unlicensed drugs, with around half each being imported and formula drugs. Among all patients, 34% were prescribed at least one unlicensed drug. Younger paediatric patients were prescribed more unlicensed drugs than older paediatric patients (newborns: 15.8% of prescriptions, infants: 13.4%, children: 10.6%, adolescents: 7.1%). Ibuprofen suppositories, midazolam oral solution and gentamicin i.v. solution were the most frequently prescribed imported drugs. Macrogol powder, lisinopril oral suspension and potassium chloride i.v. solution were the most frequently prescribed formula drugs. The most common drug forms in unlicensed use were oral liquid forms and i.v. solutions. Unlicensed drugs had a significantly higher rate of prescribing errors than licensed drugs (31.6 errors per 100 prescriptions [95% CI: 26.1–37.0] versus 24.3 errors per 100 prescriptions [95% CI: 22.3–26.2], p = 0.024). In particular, formula drugs carried a higher risk (36.4 errors per 100 prescriptions, p = 0.012). CONCLUSIONS: Unlicensed drugs are frequently prescribed in this paediatric hospital setting in Switzerland. Around every tenth prescription is an unlicensed drug. Because unlicensed drugs showed a significantly higher rate of prescribing errors, licensed drugs are favourable in terms of medication safety and should be prescribed whenever possible. If no licensed drug is available, imported drugs should be favoured over formula drugs due to lower prescribing error rates. To increase medication safety in paediatrics in Switzerland, efforts are necessary to increase the number of suitable licensed drug formulations for paediatric patients, including developing new innovative drug formulations for children.

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来源期刊

Swiss medical weekly 医学-医学：内科

CiteScore

5.00

自引率

0.00%

发文量

审稿时长

3-8 weeks

期刊介绍： The Swiss Medical Weekly accepts for consideration original and review articles from all fields of medicine. The quality of SMW publications is guaranteed by a consistent policy of rigorous single-blind peer review. All editorial decisions are made by research-active academics.