2023 年 5 月至 6 月期间法特马瓦蒂医院住院患者 Teratai 药房配药错误的风险因素识别

Aprilia Wulandari
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摘要

用药错误是指由于医务人员在治疗时使用了实际上能够克服的药物、行动和治疗方法而对患者造成损害的情况。经常发生的一种用药错误是配药错误。本研究的目的是找出法特玛瓦蒂医院 Teratai 住院病房药房配药阶段的用药错误。研究方法是前瞻性观察和描述性分析。数据处理采用矩阵分析法,根据危险类型对风险和事故类型进行分级,以描述发生的事故和配药阶段的用药错误。符合要求的所有处方的研究样本在法特马瓦蒂医院 Teratai 大楼的药房仓库住院部进行。研究时间为 2023 年 5 月至 6 月。共有 995 份配方,其中多达 2 份配方在配药阶段出现偶然样本错误。研究结果显示,配药阶段的用药错误包括药物摄入量错误(0%)、剂量计算错误(0%)、剂量强度错误(0%)、项目数量错误(0%)、标签书写错误(0%)、剂型错误(0%)和空药库存(1.19%)。患者安全事件的类型为 KTD,而法特玛瓦蒂医院住院部药剂服务相关用药错误的风险分级矩阵分析结果显示,风险分级类型为低。
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A Identification Of Risk Factors In Dispensing Error In Pharmaceutical Deposit Inpatient Teratai At Fatmawati Hospital Period May-June 2023
Medication error is a situation that is detrimental to the patient due to the use of drugs, actions, and treatments since the time of treatment by health workers that are actually able to overcome. One-of-a kind medication errors that often happen are dispensing errors. The purpose of this research is to identify medication errors during the dispensing phase at the Pharmacy Depot of Teratai Inpatient Installation at Fatmawati Hospital. The research method is prospective observation with descriptive analysis. Data processing is done using matrix analysis, grading risks and types of incidents based on the type of hazard to describe incidents and medication error phase dispensing that happened. The research samples of all prescriptions that met the requirements were carried out at the Pharmacy Depot Inpatient Installation at the Teratai Building at Fatmawati Hospital. The research was conducted from May to June 2023. There were 995 recipes with incidental sample errors in as many as 2 recipes in the dispensing phase. The results of the research show that medication errors at the dispensing stage include wrong drug intake (0%), wrong dosage calculation (0%), wrong dosage strength (0%), wrong number of items (0%), wrong label writing (0%), wrong dosage form (0%), and empty drug stock (1.19%). The type of patient safety incident was a KTD, while the results of the risk grading matrix analysis of medication errors related to pharmaceutical services at the inpatient installation of Fatmawati Hospital found that the type of risk grading was low.
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