时间：2022-10-14 09:35:46
BACKGROUND： Medication errors are a common source of adverse healthcare incidents particularly in the emergency department （ED） that has a number of factors that make it prone to medication errors. This project aims to reduce medication errors and improve the health and economic outcomes of clinical care in Hong Kong ED.
METHODS： In 2009， a task group was formed to identify problems that potentially endanger medication safety and developed strategies to eliminate these problems.
RESULTS： Responsible officers were assigned to look after seven error-prone areas. Strategies were proposed， discussed， endorsed and promulgated to eliminate the problems identified. A reduction of medication incidents （MI） from 16 to 6 was achieved before and after the improvement work.
CONCLUSION： This project successfully established a concrete organizational structure to safeguard error-prone areas of medication safety in a sustainable manner.
KEY WORDS： Medication error； Medication safety； Continuous Quality Improvement （CQI）
World J Emerg Med 2013；4（3）：179182
DOI： 10.5847/ wjem.j.19208642.2013.03.004
INTRODUCTION
Medication errors are a common cause of adverse healthcare incidents that impact on the quality of care. Medication errors may account up to one-third of all medical errors in hospital.[1] Of course， not all medication errors lead to morbidity or mortality but the relatively high incidence makes it a problem still worth dealing with. The emergency department （ED） is at the front line of preventing medication error and the first we need to do is to raise our awareness of the problem and choose strategies to eliminate the error and mitigate harm if errors do occur.[2]
This project aims to reduce medication errors and improve the health and economic outcomes of clinical care in the ED through a continuous quality improvement （CQI） cycle.
METHODS
This project began in the third quarter of 2009 and went on until the end of year 2011. A task group was formed to identify problems and develop strategies to reduce medication error. This task group was composed of staff from multiple professional groups and grades including emergency specialists， resident trainees， nursing officers and registered nurses. There were three phases to the project：
Phase 1 （problem identification）
A. Seven error-prone areas： 1） drug allergy； 2）charting of medication administration record （MAR）； 3）high risk medication； 4） intravenous devices & infusion； 5） look-alike sound-alike （LASA） drugs； 6） drug storage & replenishment and； and 7） prescription practice under computerized medication order entry （MOE）.
The ED renovation started in the first quarter of 2011 with elements of medication safety that had been incorporated into our renovation plan so as to avoid unnecessary secondary storage within clinical area and potential public access to medications. Locations of secondary drug storage were minimized from four to one. Lastly， the risk of ED dispensing was greatly reduced after the working hours of the hospital pharmacy were extended from 8 to 14 hours. As a consequence， stock of pre-packed medication items were re-estimated and optimized to fit in the new ED nursing station.
With respect to the hospital authority advanced incidents reporting system （AIRS）， there was 16 medication incidents （MI） of our department between 2008 and 2010 and was dropped to 6 only from 2011 till now with a comparable number of attendances.
DISCUSSION
Many factors contribute ED to making the ED a hotbed of medication errors. These include multiple patients being treated concurrently， frequent reliance on verbal orders， a wide range of high-risk medications， a variety of administration routes， time pressures， ED dispensing and interruption and distractions.[3] In addition， the ED is also expected to manage complex error-prone procedures involving drug administration， for example， administration of thrombolytic agents and conscious sedation drugs. Other factors associated with medication errors include lower triaged level patients， time of day （more errors during weekend and night shifts[4]） and LASA drugs.
Medication use is a complicated process and benefits from simplification and regular review. Traditionally， the ED in Hong Kong has intricate medication item lists： 1） top-up； 2i） GF277 （drug items that available as pre-packed）； 3） basket item lists （mainly intravenous fluids and topical treatment）， and even leftover drugs. These lists containing items that sometimes are overlapped， sometimes are seldom used， and sometimes are of a high-risk nature. Storage of dangerous drugs and high-risk medications should be centralized for safety， regardless of healthcare providers' inconvenience， enabling a working environment with minimal distraction.[2，5]
There are five stages of drug ordering and delivery in the ED： 1） prescription； 2） transcription； 3） dispensing； 4） administration； and 5） monitoring. Each of these stages represents a vulnerable link in a chain along which any variety of errors can occur. The two most common factors associated with prescribing errors are lack of knowledge about the drug prescribed and lack of knowledge regarding the patient for whom the drug is prescribed.[6] The best way to eliminate error arising from this stage is to achieve standardization of complex medication processes such as standardization of IVI dilution regimen of high-risk medications.[5]