急诊室中儿童用药安全的18条建议
彭静 译
美国儿科学会儿科急救医学委员会、美国急诊医师学会儿科急救医学委员会、急救护士协会儿科急救医学委员会共同发布：
在急诊科住院的儿科病人（ED）由于各种原因而处于用药错误的高风险中。美国儿童紧急医疗服务处和美国儿科学会儿科急诊医学委员会召集一个多学科小组发起了一场关于ED的药物安全性的讨论。文中指出改善用药安全性的最佳策略包括：使用按公斤体重计算给药剂量方案，通过使用计算机临床决策方案优化医生的医嘱输入，在考虑药物浓度变异性的同时为儿童患者制定标准剂量计算公式，为ED提供药剂师技术支持，加强对医务专业人员的培训，在ED中对药物进行系统化的调配和管理，并在出院前解决家庭用药管理方面的挑战。
1、为儿童高警示和常用药物制定标准处方；
2、规范高警示药物的浓度；
3、使用最小有效浓度；
4、提供推荐的预计算剂量；
5、只使用公斤为单位测量和记录体重；
6、当无法获取体重时，可使用身长为基础的药物剂量计算公式；
7、落实及为ED提供药剂师技术支持；
8、最大程度采用最佳实践处方和剂量范围的标准化嵌入式指令组；
9、促进药物无干扰调配安全区的发展;
10、对医嘱执行过程进行监控，例如对高警示药物进行双人独立检查；
11、使用含有儿科专用剂量规则（以公斤体重计算）的电子医嘱录入系统（CPOE）和临床决策支持（CDS），包括ED信息系统中的药物剂量上限的控制；
12、鼓励社区服务机构为用药史复杂的儿童保留最近的药物清单和紧急情况信息表，以便提供紧急护理；
13、建立专门的儿科药物安全课程，并将护士、医生、呼吸治疗师、执业护士、医生助理、院前急救提供者和药剂师纳入其培训方案；
14、开发资格评估工具；
15、配发家庭服用液体药物的标准化喂药装置；
16、配发可供家庭中使用的以毫升为剂量的液体药物；
17、在对家人进行用药教育时，采用先进的策略，例如Teach-back模式，即通过让病人用自己的语言复述医护人员所提供的信息，以评估其回忆和理解力的教学策略；
18、提供图像化的、简单易懂的给药指导说明。
Pediatric Medication Safety in the Emergency Department
Pediatric patients cared for in emergency departments (EDs) are at high risk of medication errors for a variety of reasons. A multidisciplinary panel was convened by the Emergency Medical Services for Children program and the American Academy of Pediatrics Committee on Pediatric Emergency Medicine to initiate a discussion on medication safety in the ED. Top opportunities identified to improve medication safety include using kilogram-only weight-based dosing, optimizing computerized physician order entry by using clinical decision support, developing a standard formulary for pediatric patients while limiting variability of medication concentrations, using pharmacist support within EDs, enhancing training of medical professionals, systematizing the dispensing and administration of medications within the ED, and addressing challenges for home medication administration before discharge.
1.Create astandard formulary for pediatric high-risk and commonly used medications;
2.standardizeconcentrations of high-risk medications;
3.reduce thenumber of available concentrations to the smallest possible number;
4.providerecommended precalculated doses;
5.measure andrecord weight in kilograms only;
6.uselength-based dosing tools when a scale is unavailable or use is not feasible;
7.implement andsupport the availability of pharmacists in the ED;
8.usestandardized order sets with embedded best practice prescribing and dosingrange maximums;
9.promote thedevelopment of distraction-free medication safety zones for medicationpreparation;
10.mplementprocess screening, such as a 2-provider independent check for high-alertmedications;
11.implement anduse CPOE and CDS with pediatric-specific kilogram-only dosing rules, includingupper dosing limits within ED information systems;
12.encouragecommunity providers of children with medical complexity to maintain a currentmedication list and an emergency information form to be available for emergencycare;
13.create andintegrate a dedicated pediatric medication safety curriculum into trainingprograms for nurses, physicians, respiratory therapists, nurse practitioners,physician assistants, prehospital providers, and pharmacists;
14.develop toolsfor competency assessment;
15.dispensestandardized delivery devices for home administration of liquid medications;
16.dispensemilliliter-only dosing for liquid medications used in the home;
17.employ advancedcounseling such as teach-back when sharing medication instructions for homeuse;
18.usepictogram-based dosing instruction sheets for use of home medications.