药疗差错及其发生环节的分析

Medication Errors and the Stages at Which Errors Occur

目的:为减少或避免药疗差错提供参考。方法:采用文献研究方法,整理、归纳出药疗差错的定义,分析其发生的环节和情形。结果与结论:药疗差错是根据已有药学理论判断、发生于药物治疗过程中的、有可能导致疗效降低或对患者造成损害的可避免的行为;药疗差错可发生于药物治疗全过程中的任何环节,主要可从管理和技术方面采取措施降低其发生率。

OBJECTIVE： To provide the reference for the improvement of medication to avoid the accidents. METHODS： Literature on medication errors was reviewed and we analyzed definitions and classifications of medication errors and the stages at which medication errors occur and the scenarios when it happens. RESULTS ＆ CONCLUSIONS： A medication error is any preventable action which may lead to patient harm or reduce the effect of therapy according to pharmaceutical theory in existence during the whole medication process. It can occur at any stage, and the important approaches to mitigating errors involve the management and technology.