目的:为ICU临床医生提供关于危重病患者安全用药实践的循证指导。
方法:PubMed,Cochrane系统评价数据库,Cochrane中央控制试验登记册,CINAHL,Scopus,和ISIWebofScience获取截至2015年12月的相关材料。
方法:基于三个关键组成部分:1)环境和患者,2)用药过程中,3)患者安全监测系统。委员会集体发展人口,干预,比较器,结果问题和质量的证据陈述有关的用药错误和药物不良事件解决的关键组成部分。共有34人,干预,比较器,结果问题,证据陈述的五个质量,并发表了一篇关于披露的评论。
方法:小组委员会成员被分配了选定的人口,干预,比较器,结果问题或证据陈述的质量。小组委员会成员完成了对建议的分级评估,发展,并根据他/她的证据评估质量和建议的建议强度对问题进行评估,然后相关小组委员会审查了草案。小组委员会集体审查了他们提出的每个问题的证据概况。草案经全体委员会讨论通过后,然后该文件在所有成员中分发,以就证据的质量和建议的强度进行表决。
结果:委员会遵循建议分级评估的原则,发展,和评估系统,以确定证据的质量和建议的强度。
结论:本指南将ICU环境评估为药物相关事件的风险,并评估环境变化对提高安全用药的影响。药物相关事件的预防策略按药物使用过程节点(处方,分布,administration,监测)。主动监控系统的详细考虑,包括报告,identification,并对评价进行了讨论。此外,强调的是,未来需要研究特定于危重病人的安全用药实践。
OBJECTIVE: To provide ICU clinicians with evidence-based guidance on safe medication use practices for the critically ill.
METHODS: PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, and ISI Web of Science for relevant material to December 2015.
METHODS: Based on three key components: 1) environment and patients, 2) the medication use process, and 3) the patient safety surveillance system. The committee collectively developed Population, Intervention, Comparator, Outcome questions and quality of evidence statements pertaining to medication errors and adverse drug events addressing the key components. A total of 34 Population, Intervention, Comparator, Outcome questions, five quality of evidence statements, and one commentary on disclosure was developed.
METHODS: Subcommittee members were assigned selected Population, Intervention, Comparator, Outcome questions or quality of evidence statements. Subcommittee members completed their Grading of Recommendations Assessment, Development, and Evaluation of the question with his/her quality of evidence assessment and proposed strength of recommendation, then the draft was reviewed by the relevant subcommittee. The subcommittee collectively reviewed the evidence profiles for each question they developed. After the draft was discussed and approved by the entire committee, then the document was circulated among all members for voting on the quality of evidence and strength of recommendation.
RESULTS: The committee followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation system to determine quality of evidence and strength of recommendations.
CONCLUSIONS: This
guideline evaluates the ICU environment as a risk for medication-related events and the environmental changes that are possible to improve safe medication use. Prevention strategies for medication-related events are reviewed by medication use process node (prescribing, distribution, administration, monitoring). Detailed considerations to an active surveillance system that includes reporting, identification, and evaluation are discussed. Also, highlighted is the need for future research for safe medication practices that is specific to critically ill patients.