ABSTRACT
OBJECTIVES: Knowledge of the prevalence and characteristics of medication errors in pediatric and neonatal patients is limited. This study aimed to evaluate the incidence and medication error characteristics in a pediatric hospital over 5 years and to determine whether serial error prevention programs to optimize a computerized physician order entry (CPOE) system reduce error incidence. METHODS: We retrospectively reviewed medication errors documented between January 2015 and December 2019. RESULTS: A total of 2,591,596 prescriptions were checked, and 255 errors were identified. Wrong dose prescriptions constituted the most common errors (56.9%). Medications with the highest rate of errors were antibiotics/antiviral drugs (36.9%). Oral route medications comprised the highest portion (60.8%), followed by intravenous ones (28.6%). The most common stage for medication errors was physician ordering (93.3%). Junior residents were responsible for most errors (45.9%). Most errors occurred in the pediatric ward (53.7%). In total, 221 (86.7%) errors were near misses. Only 4 errors (1.6%) were considered significant and required active monitoring or intervention. Type of error, stage of error, staff composition, and severity level of errors were significantly related to the number of errors in different years. There was a statistically significant decrease in errors per 100,000 prescriptions across different years after optimizing the CPOE system. CONCLUSIONS: The incidence of medication errors decreased with extensive use of the CPOE system. Continuous application of the CPOE optimization program can effectively reduce medication errors. Further incorporation of pediatric-specific decision-making and support tools and error prevention measures into CPOE systems is needed.
Subject(s)
Medical Order Entry Systems , Physicians , Infant, Newborn , Child , Humans , Hospitals, Pediatric , Retrospective Studies , Medication Errors/prevention & control , Medication Systems, HospitalABSTRACT
A range of biphenyl α-diazoketones containing various electron-withdrawing groups (EWG = COCH3, CN, CO2Et, COPh, SO2CH3, SO2Ph) on diazo carbon has been investigated for rhodium(ii)-catalyzed intramolecular cyclization. Among which, the α-acetyl, carboxylate and cyano substituted substrates show markedly different selectivity between aromatic substitution and aromatic cycloaddition processes, affording phenanthrol and/or benz[α]azulenone products in varying ratios. The selectivity is mainly directed by α-substitutions, and is also possibly influenced by the substituents on the biphenyl ring. Moreover, high chemoselectivity for aromatic substitution over cycloaddition is observed for the α-benzoyl and sulfonyl substituted substrates. But in addition to phenanthrols, these reactions produce aromatic ketones and/or 1,2-diketones as unprecedented products obtained from diazo precursors. Mechanistic rationales are given in the report.
ABSTRACT
One new lignan, machilolin-A (1), was isolated from the leaves of Machilus zuihoensis Hayata var. mushaensis (Lu) Y. C. Liu (Lauraceae), together with three known compounds, vanillin (2), beta-sitosterol (3) and stigmasterol (4). The structure of 1 was elucidated based on chemical analysis and spectral methods (IR, 1D and 2D NMR, HR-FAB-MS, EI-MS).
