心血管内科给药护理不良事件发生频率及相关因素分析

摘要

目的 观察心血管内科给药护理不良事件的发生频率,并对其相关因素进行分析.方法 采用便利抽样法选择2015年1月在广州军区武汉总医院心血管内科住院的328例患者,及执行给药护理操作的所有护理人员为研究对象.表格式记录护士进行给药操作的所有项目及不良事件发生情况.将给药不良事件分为医嘱类不良事件、抄写类不良事件和给药类不良事件3类(27项),采用相关性分析探讨不良事件发生的因素.结果 共观察给药护理1643次,发生给药不良事件246例,发生率为14.97%.研究中已发生的不良事件均为Ⅰ~Ⅱ级,未对患者造成任何伤害;其中医嘱类给药不良事件发生65例,抄写类不良事件发生76例,给药类不良事件发生105例.药品种类因素中,心血管系统中扩血管药、抗心律失常药不良事件发生与输液速度(医嘱类)呈正相关(r值分别为0.053,0.046;P<0.05);降压药、降脂药及抗血小板药不良事件发生与遗漏(抄写类)呈正相关(r值分别为0.037,0.062,0.044;P<0.05);抗凝药不良事件发生与遗漏(给药类)、给药频率失误(给药类)呈正相关(r值分别为0.075,0.034;P<0.05).给药途径因素中,口服与遗漏(抄写类)呈正相关(r=0.025,P<0.05),静脉推注与输液速度(医嘱类)呈正相关(r=0.067,P<0.05),静脉滴注与技术失误(给药类)呈正相关(r=0.036,P<0.05).护士及患者一般情况因素中,剂量错误(超量、少量)与夜班及周末班患护比例高相关(r=0.072,P<0.05),药物之间相互作用与护士工作年限低相关(r=0.045,P<0.05).结论 心血管内科护理不良事件的发生与患护比高、护士工作经验不够、心血管药物种类繁多、给药方式复杂等相关,管理者需从这些方面入手改进,提高护理质量.%Objective To investigate the incidence of medication errors ( MEs ) in Cardiovascular Department and to analyze the reasons to the adverse events. Methods According to convenient sampling method, the study selected 328 patients who were hospitalized in Cardiovascular Department of Wuhan General Hospital of Guangzhou Military in January 2015. The medication details and adverse events ( including prescription, transcription, and administration) would be carefully recorded. The possible reasons would be interpreted by correlation analysis. Results In general, the incidence rate of MEs was 14. 97% (246/1643) and all of the adverse events wereⅠ-Ⅱdegree and did not harm the patients. In these events, 65 cases concerned prescription;76 cases concerned transcription;105 cases concerned administration. In medicine analysis:vasculardilation drugs and antiarrhythmic drugs′ MEs had positive correlation with infusion speed ( r=0. 053, 0. 046;P<0. 05); antihypertensive drugs, lipid-lowing drugs and antiplatelet drugs′ MEs had positive correlation with transcription omission (r=0. 037, 0. 062, 0. 044; P <0. 05); anticoagulants′ MEs had positive correlation with transcription omission and administration frequency errors (r=0. 075, 0. 034; P<0. 05). In administration route analysis, oral had positive correlation with transcription omission (r=0. 025, P<0. 05);intravenous injection had positive correlation with infusion speed ( r =0. 067, P <0. 05 ); intravenous drip had positive correlation with technical errors (r=0.036, P<0. 05). In nurses and patients′ general conditions factors, dose errors (excess or insufficient) had positive correlation with high patient-nurse ratio at night and weekend (r=0. 072, P<0. 05);drug interaction had positive correlation with nurses′ working experiences (r =0. 045, P<0. 05). Conclusions The incidence of MEs in Cardiovascular Department is related to high patient-nurse ratio, insufficient working experiences, great varieties of cardiovascular drugs and complicated administration methods. The director should improve the quality of nursing care from above aspects.