加護病房靜脈同時給予多種藥品之型態與風險

對某醫學中心11個加護病房的護理師問卷調查，以了解同時靜脈給多種藥的型態與風險。先依據前一年6個月的醫囑製作「高頻次靜脈用藥清單」，做為問卷之附件。問卷分三部份：（一）依經驗填答頻次與原因；（二）依附件選填常同時給藥組合；（三）依經驗填寫附件以外藥品之不相容組合。依127位受訪者經驗，79.5％ 1天至少1次同時靜脈给藥，91.3％原因為「同一時間有多個藥品需要輸注」；有81.1％「由Y型輸液接頭、中央靜脈導管或三通連接閥同時給藥」。依據附件共填選1066組（含重複）常同時給藥者，歸納為555種。1066組中28.2％同時給至少3種藥，最多18種藥。護理師曾觀察到48組不相容，加上經驗中其他藥品不相容，共99種不相容組合。31.3％與文獻一致；41種與文獻相左，可供臨床參考及進一步研究。Furosemide、全靜脈營養（total parenteral nutrition）與重碳酸鈉（Sodium bicarbonate）有最多不相容性。

關鍵字

藥品不相容性；注射劑；靜脈輸注；藥物錯誤

並列摘要

A questionnaire survey was delivered to nurses at 11 intensive care units (ICUs) in a medical center to explore the pattern and risks of concurrent administration of intravenous (IV) drugs. A list of the frequently used IV drugs in ICUs was generated according to physician's orders in the last six months of the previous year and used as an appendix of the questionnaire. The questionnaire consisted of 3 parts: (1) frequency and methods of concurrent IV drug administration according to practice experiences; (2) sets of drugs in the appendix that concurrent administration was frequent; and (3) incompatible combination of drugs other than those listed in the appendix observed by nurses. Among the 127 respondents, 79.5% gave IV drugs concurrently at least once a day; 91.3% were due to many drugs to be administered at the same time; and 81.1% were given via Y-site, central venous catheter, or 3-way concurrently. A total of 1066 sets of drugs (including repeated ones) that were frequently administered concurrently could be categorized into 555 different kinds of combination. Of the 1066 sets, 28.2% had at least 3 drugs administered concurrently, some even up to 18 drugs. In addition to 48 incompatible sets found according to drugs listed on the appendix, nurses listed incompatible sets of drugs other than those listed in the appendix to make a total of 99 incompatible combinations. Among these combinations, 31.3% were in concordance with literature reports, but 41 sets were different from literature reports, which can be used as a clinical reference, and for studies in the future. Furosemide, total parenteral nutrition and NaHCO_3 accounted for the most incompatibilities.

並列關鍵字

drug incompatibility ； injections ； infusion ； medication errors

參考文獻

de Vries EN, Ramrattan MA, Smorenburg SM, et al. The incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care 2008;17:216-23.

Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA 1995; 274:29-34.

Morimoto T, Sakuma M, Matsui K, et al. Incidence of adverse drug events and medication errors in Japan: the JADE study. J Gen Intern Med 2011;26:148-53.

Taxis K, Barber N. Causes of intravenous medication errors: an ethnographic study. Qual Saf Health Care 2003;12:343-7.

Cousins DH, Sabatier B, Begue D, et al. Medication errors in intravenous drug preparation and administration: a multicentre audit in the UK, Germany and France. Qual Saf Health Care 2005;14:190-5.

國際替代計量

加護病房靜脈同時給予多種藥品之型態與風險

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