药物流行病学和药物安全性的进展

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Medication Safety in Hospitals: Avoiding Medication Errors in the Medication Use Process

Samaranayake NR and Cheung BMY

Medication errors have a large impact on patient safety and on healthcare costs. Although errors happen at every stage of the medication use process, the ones that occur in the latter part of the process are frequently undetected. Therefore, while all medication errors need to be eliminated, the ones that frequently reach the patient should be stopped first. Errors occur due to a combination of human and system-related failures. However, improving the system seems to be the prudent approach to avoiding medication errors, as human failures are inevitable. Efforts to improve systems include two broad areas. One is the automation of systems and the other is to improve the quality of prescription writing. Technologies have improved the safety of the medication use process to a large extent but this success depends on user acceptance. If technologies are difficult to use, users may work around standard procedures resulting in new and unanticipated errors. Bar-code assisted medication administration is one such useful technology which is commonly associated with implementation problems and workarounds. Therefore adequate preplanning, user attitude assessments and post-implementation assessments are three vital aspects of implementing new technology. Improving the quality of prescriptions is also a very useful strategy to improve medication safety, because a large percentage of hospitals still use hand-written prescriptions. The use of error-prone abbreviations has been shown to be very dangerous as pharmacists and nurses may misinterprit them, especially if the prescriptions are illegible. A popular approach to discourage error-prone abbreviations in prescriptions is through a ‘Do Not Use’ list; a list showing error-prone abbreviations that should be avoided by prescribers. However, its effectiveness and adherence by healthcare professionals has not been established. In conclusion, medication errors have a large impact on patient safety and interventions aimed at minimising them need careful planning and implementation.