🛡️ 安全与感染预防 · 第5课，共6课 · 6 min
给药原则，以及战胜它们的差错
The Rights of Medication Administration and the Errors That Beat Them
💊 一个病房里有两位都叫Williams的患者。一袋看起来像生理盐水的钾溶液。一句口头医嘱中的“十五”，听起来却像“五十”。历史上每一起用药差错，其实都早已有一条规则写出来防止它发生。
💊 Two clients named Williams on one unit. A bag of potassium that looks like a bag of saline. A verbal order for 'fifteen' that sounded like 'fifty'. Every medication error in history already had a rule written to prevent it.
💡 核心要点
两种标识，三次核对，任何不清楚的地方都要澄清，高警示药物有额外保障，并在政策要求时进行独立双人核对。发生差错后：评估、通知、治疗、记录事实、报告。
Two identifiers, three checks, clarify anything unclear, extra safeguards for high-alert drugs, with an independent double check where policy requires it. After an error: assess, notify, treat, document facts, report.
🧠 为什么重要
核心原则：正确的患者（使用姓名和出生日期等两种标识，与医嘱和腕带核对，绝不能用病房号）、正确的药物、正确的剂量、正确的给药途径、正确的时间和正确的记录，另外还有拒绝权、受教育权、评估权和评价权。对照医嘱核对药物三次：取药时、配药时和床旁给药时。任何字迹不清、不完整或看起来不安全的医嘱，在给药前都要先澄清；绝不能猜测。避免使用易出错的缩写和尾随零（写5 mg，不要写5.0 mg），并且始终使用前导零（0.5 mg，不要写.5 mg）。高警示药物，如insulin、heparin、阿片类药物、浓电解质和化疗药物，造成严重伤害的风险更高。遵循机构政策进行独立双人核对，这通常是IV insulin、heparin输注、PCA和硬膜外阿片类药物、IV浓电解质和化疗所必需的。配药期间尽量减少被打扰。如果发生差错：评估患者，通知医务人员，执行任何医嘱，在病历中记录客观事实而不提及事件报告，并填写事件报告。
The core RIGHTS: right CLIENT (two identifiers such as name and date of birth, checked against the order and the band, never the room number), right DRUG, right DOSE, right ROUTE, right TIME, and right DOCUMENTATION, with the rights to refuse, to education, to assessment and to evaluation. Check the medication against the order three times: when retrieving it, when preparing it, and at the bedside. Clarify any order that is illegible, incomplete or seems unsafe before giving it; never guess. Avoid error-prone abbreviations and trailing zeros (write 5 mg, not 5.0 mg) and always use a leading zero (0.5 mg, not .5 mg). HIGH-ALERT medications such as insulin, heparin, opioids, concentrated electrolytes and chemotherapy carry a higher risk of serious harm. Follow facility policy for an independent double check, which is typically required for IV insulin, heparin infusions, PCA and epidural opioids, IV concentrated electrolytes and chemotherapy. Minimize interruptions during preparation. If an error occurs: assess the client, notify the provider, carry out any orders, document the objective facts in the chart without mentioning the incident report, and file an incident report.
🏥 真实场景
🏷️ 一名护士走进病房，喊道：Mr。她问的是不是Williams，而听力不好的患者点了点头。认错了Williams。腕带本来会说明这一点。考试的正确答案永远是核对标识，绝不是患者的点头、室友的提示或门上的名字。
🏷️ A nurse enters a room, says 'Mr. Williams?' and the client, hard of hearing, nods. Wrong Williams. The band would have said so. The exam's correct answer is always the identifier check, never the client's nod, the roommate's hint or the name on the door.
📌 要点总结
- 用腕带上的两种标识，绝不能用病房号Two identifiers from the band, never the room number
- 三次核对；澄清不清楚的医嘱；不用尾随零，始终用前导零Three checks; clarify unclear orders; no trailing zeros, always leading zeros
- 高警示药物有额外保障，并按机构政策进行独立双人核对，尤其是IV输注和PCAHigh-alert drugs get extra safeguards, with an independent double check per facility policy, especially for IV infusions and PCA
📖 本课术语
高警示药物 (High-alert medication): 如insulin、heparin、阿片类药物或浓缩电解质等药物，若给药错误，发生严重伤害的风险很高；需要保障措施，包括按机构政策进行独立双重核查。
✅ 自我测试
哪项行动能在给药前正确识别患者？Which action correctly identifies a client before medication administration?
- 查看门上的姓名和病房里的白板Checking the name on the door and the whiteboard in the room
- 将腕带上的姓名和出生日期与病历核对Comparing the band's name and date of birth with the record
- 请室友确认患者的姓名Asking the roommate to confirm the client's name
- 问“你是Lopez夫人吗？”并等待患者点头Asking 'Are you Mrs. Lopez?' and waiting for the client to nod
答案: B · 将腕带上的姓名和出生日期与病历核对
将腕带上的两种标识与病历核对。用是非问题询问，容易让意识混乱或听力受损的患者错误地表示同意。
Two identifiers from the band compared with the record. Asking a yes/no question invites a confused or hearing-impaired client to agree wrongly.
一份医嘱写着“Digoxin .25 mg PO daily.”，护士应该怎么做？An order reads 'Digoxin .25 mg PO daily.' What should the nurse do?
- 给25 mg，按没有小数点来读这份医嘱Give 25 mg, reading the order without the decimal point
- 扣住药物，等待下一次药房审核Hold the drug and wait for the next pharmacy review
- 先向开医嘱者澄清这份医嘱Clarify the order with the prescriber first
- 给2.5 mg，因为小数点显然放错了位置Give 2.5 mg because the decimal was clearly misplaced
答案: C · 先向开医嘱者澄清这份医嘱
缺少前导零可能会被误读为25 mg，那是致死剂量。不清楚的医嘱要在给药前澄清。扣住药物等待下一次药房审核会拖延澄清，并让一份不安全的医嘱悬而未决，而不是让开医嘱者立即更正。
A missing leading zero can be misread as 25 mg, a lethal dose. Unclear orders are clarified before administration. Holding the drug until the next pharmacy review delays clarification and leaves an unsafe order unresolved instead of getting the prescriber to correct it now.
护士意识到20分钟前给错了降压药的剂量，第一个行动是什么？A nurse realizes the wrong dose of an antihypertensive was given 20 minutes ago. What is the first action?
- 在班次结束前填写事件报告Complete the incident report before the end of the shift
- 什么都不告诉患者，以免引起恐慌Tell the client nothing happened to avoid causing alarm
- 等一个小时看症状是否出现Wait to see if symptoms develop over the next hour
- 评估患者的血压和状况Assess the client's blood pressure and condition
答案: D · 评估患者的血压和状况
患者安全第一：先评估，然后通知医务人员，按医嘱治疗，记录事实并填写报告。
Client safety first: assess, then notify the provider, treat as ordered, document facts and file the report.
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