基于处方的儿童高警示药品使用情况调查

Investigation on the use of high‑alert medications for children in prescriptions

目的了解儿科门急诊处方、住院医嘱中儿童高警示药品(HAM)使用状况。方法收集首都医科大学附属北京妇产医院怀柔妇幼保健院2016年7月1日至2018年6月30日年龄<18岁患者的所有门急诊处方和住院医嘱,根据《中国儿童高警示药品目录》,对处方/医嘱中儿童HAM使用情况进行回顾性分析。结果共收集到处方/医嘱297968张,包括门急诊处方270024张(90.62%),住院医嘱27944张(9.38%);处方涉及的患儿包括男性162521例次(54.54%),女性135447例次(45.46%);年龄(4±3)岁,范围0~17岁;每张处方药品种数为(2±1)种,范围1~9种。297968张处方/医嘱中涉及儿童HAM处方23476张(7.88%),门急诊处方中儿童HAM处方占比明显高于住院医嘱[7.92%(21381/270024)比7.50%(2095/27944),P=0.013],外科处方/医嘱中儿童HAM处方占比[32.84%(1220/3715)]明显高于内科[8.17%(22043/269777)]和其他科室[0.87%(213/24476)],差异均有统计学意义(均P<0.001)。23476张处方涉及儿童HAM共13类42种,使用26084例次。使用频次排名前3位的药物类型包括中药注射剂(8694例次、33.33%)、解热镇痛抗炎药(7505例次、28.77%)和抗感染药物(4011例次、15.38%),排名前10位的儿童HAM分别为对乙酰氨基酚、炎琥宁注射液、喜炎平注射液、维生素K1、阿糖腺苷、破伤风抗毒素、青霉素类、苯巴比妥、异丙嗪注射剂和肝素。因儿童HAM用药错误导致9例患儿发生不良事件,均为E级,涉及的药物包括喜炎平注射液、对乙酰氨基酚和维生素K1注射液。结论儿童HAM使用较普遍,中药注射剂相关HAM使用较多,门急诊和外科处方中含儿童HAM占比较高。儿童HAM相关用药错误可能导致严重不良事件,应加强管理。

Objective To understand the usage status of high‑alert medicines(HAM)for children in outpatient and emergency prescriptions and inpatient medication orders at department of pediatric.Methods All outpatient and emergency prescriptions and inpatient medication orders in patients with an age of<18 years between July 1,2016 and June 30,2018 in Huairou Maternal and Child Health Hospital Affiliated to Beijing Obstetrics and Gynecology Hospital,Capital Medical University were collected.According to the List of High‑Alert Medications for the Chinese Children,the use of HAM for children in prescriptions and medication orders was analyzed retrospectively.Results A total of 297968 prescriptions and medi‑cation orders were collected in the study,including 270024 outpatient and emergency prescriptions(90.62%)and 27944 inpatient medication orders(9.38%).There were 162521 prescriptions(54.54%)involving male children and 135447(45.46%)involving female children with an age of(4±3)years,ranged 0‑17 years.The number of drugs included in each prescription was(2±1),ranged 1‑9.Of the 297968 prescriptions and medication orders,23476(7.88%)involved HAM for children.The proportion of prescrip‑tions containing HAM for children in outpatient and emergency prescriptions was significantly higher than that in inpatient medication orders[7.92%(21381/270024)vs.7.50%(2095/27944),P=0.013];the proportion of prescriptions and medication orders containing HAM for children in Surgery Department[32.84%(1220/3715)]was significantly higher than that in Medicine Department[8.17%(22043/269777)]and other departments[0.87%(213/24476)],and the difference was statistically significant(all P<0.001).The 23476 prescriptions involved 13 categories and 42 kinds of HAM for children and the total frequency of HAM for children was 26084.The top 3 drug categories that most frequently used were tradi‑tional Chinese medicine injections(8694,33.33%),antipyretic analgesic and anti‑inflammatory drugs(7505,28.77%),and anti‑infective drugs(4011,15.38%);the top 10 HAM for children that most frequently used were paracetamol,Yanhuning injection(炎琥宁注射液),Xiyanping injection(喜炎平注射液),vitamin K1,vidarabine,tetanus antitoxin,penicillins,phenobarbital,promethazine injections,and heparin.Adverse events occurred in 9 children due to medication errors of HAM for children,which were all grade E,and the drugs involved were Xiyanping injection,paracetamol,and vitamin K1 injection.Conclusions HAM for children was commonly used,among which the traditional Chinese medicine injection‑related HAM was used more,and the proportion of prescriptions containing HAM for children was higher in departments of out‑patient,emergency,and surgery.Medication errors related to HAM for children may lead to serious adverse events,so the management of HAM for children should be strengthened.