加護病房用藥疏失之分析與改善

MEDICATION ERRORS IN HOSPITAL INTENSIVE CARE UNITS: ANALYSIS OF CAUSES AND SOLUTIONS

背景與目的：因為加護病房病人有複雜的病況，器官功能受損，以及多重用藥的問題，雖然各醫院都致力於減少用藥疏失，然而這對加護病房的病人可能還不足夠。因此本研究旨在探討本院用藥疏失的發生率與相關的危險因子，以達到持續的品質提升。

研究方法：本研究收納在2013年1月至2014年6月入住成人加護病房之病人，組成一個專家小組依前瞻性的方式評估加護病房住院期間所有處方的適當性，將發現的用藥疏失依據「安全性」、「有效性」、「適應症」、「不良給藥方式」四個基準歸類，並比較有用藥疏失與沒有用藥疏失病人的背景資料。

研究結果：研究期間共有2915名病人入住加護病房，我們在156名病人上發現了196個用藥疏失，發生率為5.35%（156/2915）。這些病人的平均年齡為72.1 ± 15.7歲，男性占55.1％。用藥疏失的歸類如下：最高為安全性（43.9％），其他分別是有效性（26.0％），適應症（16.8％），不良給藥方式（13.3％）。最常錯誤的藥物類別為抗生素（46.3％），心血管用藥（19.3％）與胃腸藥（17.4％）其次。曾發生用藥疏失的病人有較高的加護病房死亡率（p<0.0001）。多元回歸分析結果顯示有與用藥疏失顯著相關的危險因子包括：APACHE II分數>10 （O.R.=3.02），入住內科加護病房（O.R.=2.23），加護病房入住天數>3天（O.R.=5.29）。

結論：目前醫院的預防措施仍無法有效的避免加護病房病人的用藥疏失，故必須再提升資訊系統的功能，以及加強醫護人員的教育。此外，臨床藥師在團隊照護中更應扮演積極與主動的角色。

 

Objectives: Efforts made to reduce medication errors in the hospital setting might be inadequate for ICU patients due to their complicated medical conditions, compromised organ function, and complex treatment regimens involving multiple medications. Therefore, the purpose of this study was to report our experience in identifying and managing medication errors in ICUs as a means of continuous quality improvement.

Methods: An ad hoc committee consisting of senior clinical pharmacists was assembled to critically appraise every medication order prescribed by ICU physicians between January 1, 2013 and June 30, 2014. All medication errors were identified and classified into at least one of the following four categories: safety, efficacy, indications, and delivery errors. The demographic data of these patients with medication errors was compared to that of ICU patients without errors.

Results: During the study period, 2,915 patients were admitted to adult ICUs. We identified 196 medication errors occurring in 156 ICU patients with an incidence rate of 5.35% (156/2,915). The average age was 72.115.7 years and the male to female ratio was 55%:45%. Medication errors related to safety were responsible for the greatest proportion of all errors identified (43.9% ), followed by efficacy (26.0%), indication (16.8%), and delivery (13.3%). The most common types of medications associated with errors were anti-infectious agents (46.3%), followed by cardiovascular (CV) agents (19.3%) and gastrointestinal (GI) agents (17.4%). Patients with medication errors were more likely to die while in the ICU (p<0.0001). According to multiple regression analyses, three risk factors were identified including APACHE II score>10 (O.R.=3.02), Medical ICU admission (O.R.=2.23), and length of ICU stay>3 days (O.R.=5.29).

Conclusions: Current measures to reduce medication errors in the ICUs appear inadequate. Additional efforts should be taken to improve the computer prescribing system and to educate medical personnel. Clinical pharmacists need to play a more active role in the care of ICU patients.