目的:药物配伍禁忌,药物错误的重要子集,在药物管理阶段威胁患者安全。尽管药物配伍禁忌的患病率很高,目前对此了解甚少,因为以前的研究主要集中在重症监护病房(ICU)设置上.为了提高病人的安全,从全面的角度扩大我们对这个问题的理解至关重要。本研究旨在通过分析医院范围内的处方和管理数据来调查药物配伍禁忌的患病率和机制。
方法:这项回顾性横断面研究,在三级学术医院进行,包括从研究机构的临床数据仓库中提取的2021年1月1日至2021年5月31日期间收治的患者数据。使用研究现场临床工作流程鉴定药物对(PC)中的潜在接触。每个PC的药物不相容性通过使用商业药物不相容性数据库来确定,Trissel™2临床药物数据库(Trissel2数据库)。确定了药物不相容的驱动因素,基于描述性分析,之后,采用多因素logistic回归分析评估入院时出现一种或多种药物不相容性的危险因素.
结果:在30,359例患者中(代表40,061例住院),分析了24,270例患者(32,912例住院)和764,501例药物处方(1,001,685例IV给药),检查合格后。根据确定PC的规则,确定了5,813,794例PC。其中,25,108(0.4%)例不兼容的PC:在处方过程中发生了391(1.6%)PC,在给药过程中发生了24,717(98.4%)PC。通过对这些结果进行分类,我们确定了以下导致药物配伍不良的驱动因素:不正确的顺序因素;不正确的给药因素;缺乏相关研究.在多变量分析中,男性患者遇到不相容的PC的风险更高,年长的,更长的停留时间,伴随着更高的合并症,并进入医疗重症监护室。
结论:我们通过分析医院范围内的药物处方和管理数据,全面描述了药物不兼容的现状。结果表明,在临床环境中经常发生药物不相容。
OBJECTIVE: Drug incompatibility, a significant subset of medication errors, threaten patient safety during the medication administration phase. Despite the undeniably high prevalence of drug incompatibility, it is currently poorly understood because previous studies are focused predominantly on intensive care unit (ICU) settings. To enhance patient safety, it is crucial to expand our understanding of this issue from a comprehensive viewpoint. This
study aims to investigate the prevalence and mechanism of drug incompatibility by analysing hospital-wide prescription and administration data.
METHODS: This retrospective cross-sectional
study, conducted at a tertiary academic hospital, included data extracted from the clinical data warehouse of the
study institution on patients admitted between January 1, 2021, and May 31, 2021. Potential contacts in drug pairs (PCs) were identified using the
study site clinical workflow. Drug incompatibility for each PC was determined by using a commercial drug incompatibility database, the Trissel\'s™ 2 Clinical Pharmaceutics Database (Trissel\'s 2 database). Drivers of drug incompatibility were identified, based on a descriptive analysis, after which, multivariate logistic regression was conducted to assess the risk factors for experiencing one or more drug incompatibilities during admission.
RESULTS: Among 30,359 patients (representing 40,061 hospitalisations), 24,270 patients (32,912 hospitalisations) with 764,501 drug prescriptions (1,001,685 IV administrations) were analysed, after checking for eligibility. Based on the rule for determining PCs, 5,813,794 cases of PCs were identified. Among these, 25,108 (0.4 %) cases were incompatible PCs: 391 (1.6 %) PCs occurred during the prescription process and 24,717 (98.4 %) PCs during the administration process. By classifying these results, we identified the following drivers contributing to drug incompatibility: incorrect order factor; incorrect administration factor; and lack of related research. In multivariate analysis, the risk of encountering incompatible PCs was higher for patients who were male, older, with longer lengths of stay, with higher comorbidity, and admitted to medical ICUs.
CONCLUSIONS: We comprehensively described the current state of drug incompatibility by analysing hospital-wide drug prescription and administration data. The results showed that drug incompatibility frequently occurs in clinical settings.