| Summary: | 碩士 === 臺北醫學大學 === 醫學資訊研究所 === 97 === Since the Institute of Medicine released a report entitled “To Err Is Human” which estimated that approximately 44000–98000 deaths each year resulting from medical mistakes in hospitals. Patient Safety has become an increasingly well-recognized public health issue in recent years. Although many researches on Patient Safety have been published, only a few medication error (ME) studies have been conducted in children. Historically, pediatric patients suffered from more adverse drug events and harms than adults. Medicine dosage is given to pediatric patients often require dosage calculation by health care professionals, and it is often regarded as an important reason to cause ME. Unique features of pediatric care such as lack of standardized dosing because of size variation in the pediatric age range may increase the risk of medical error and harm to patients, especially in the emergency department. Unfortunately, there is still no specific information system for child providing recommended dosage to improve Patient Safety in the pediatric emergency department in Taiwan.
The aims of this study were collected and arranged the information of medicines which are most prone to ME in the pediatric emergency department. And then use this information to build a pediatric dosage decision support system in the emergency department. Using this system support the health care professionals in prescribing, dispensing and administration by real-time dosage recommend which was calculated based on children’s weight. We expected that this system reduced the rate of ME and improved the safety of pediatric patient.
This study was performed in an emergency unit in a medical center in Taiwan. Initially, by literature review and a professional conference we collected the drugs most common prone to ME in the pediatric emergency care setting. Next, we collected these drugs’ information about therapeutic indications, dosage, administration, maximum dose from the drug instructions leaflet, MICROMEDEX, pediatric dosage handbook. After arranging and categorizing these drugs’ information we created an electronic database for pediatric dosage in emergency room. Subsequently, a Weight-Based Pediatric Dosage Decision Support System was designed on web interface to support the pediatric emergency care professionals (ex. physicians, pharmacists and nurses) prescribing or re-checking the dosage. Finally, the effect and performance of this system was evaluated by accuracy analysis of recommended dosage analyzing questionnaires from emergency care professionals.
34 medications were chosen as the study targets of this system. After organizing these medications’ information, we made the rules of dose calculation based on patient’s weight and built a database to manage pediatric emergency medications’ information. The results of the evaluation of this system were satisfactory. 98.3% of the recommended dosage was accuracy and 97.1% emergency staffs who involve in this study agreed that this system is beneficial to them. In the emergency staffs’ opinion, this system is beneficial to prescribe or re-check the pediatric dosage. It was not only reducing the pressure of calculation, but also reducing the rate of ME in the pediatric emergency department. By the result of this study, a specific information system for child can improve the safety on drug using, we expected that more pediatric specific clinical decision support systems will be designed and applied, thereby having more safety in the pediatric department in the future.
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