西药和中成药处方的用药错误分析

Analysis of medication errors in prescriptions of Western and Chinese patent medicines

目的:对上海市嘉定区中医医院的用药错误情况进行调查分析,以期为相关研究提供参考。方法:于2016年3-5月收集嘉定区中医医院门、急诊西药和中成药处方中的用药错误处方,按照《中国用药错误管理专家共识》中的标准统计处方中的错误内容。错误类型主要包括药品用量、品种、用法、患者身份、药物间的相互作用、错误药品是否发给患者、错误分级、患者伤害情况、引发错误的因素及发生错误的场所等。结果:500张处方中,错误内容以药品用量差错最多,占48.8%;错误等级分别为A至D级,其中B级错误处方346张(69.2%);引发错误的人员中,主治医师及初级药师的用药错误处方较多,分别为186张(37.2%)和174张(34.8%);用药错误处方主要发生的场所为门诊药房(79.0%)。结论:应完善医院信息系统,加强医院药师的在职培训,改善门诊就诊环境,规避用药差错的发生,为患者提供安全用药保障。

Objective: To investigate and analyze the medication errors in Hospital of Traditional Chinese Medicine of Jiading District, Shanghai with a view to providing references for relevant researches. Methods: From March to May 2016,the wrong prescriptions of Western medicine and Chinese patent medicines in outpatient and emergency departments of Jiading District Hospital of Traditional Chinese Medicine were collected, and according to the standards of "expert consensus on drug error management in China", the errors in prescriptions were counted. The types of errors mainly included drug dosage, variety,usage, patient identity, drug interaction, whether the wrong drug was delivered to the patient, misclassification, patient injury,factors that caused the error, and the location where the error occurred. Results: Among the 500 prescriptions, the most erroneous content was the amount of drug used, accounting for 48.8%;the error grades were from A to D grade, of which 346(69.2%) were B-grade wrong prescriptions;among the people who caused the mistakes, the attending physician and the primary pharmacist had more prescriptions for medication errors, which were 186(37.2%) and 174(34.8%), respectively;the main place where the medication error prescription occurred was the outpatient pharmacy(79.0%). Conclusion: It is necessary to improve the hospital information system, strengthen the in-service training of hospital pharmacists, improve the outpatient environment, and avoid the occurrence of medication errors so as to provide patients with safe medication.