目的:分析我国临床安全用药监测网中的用药错误(ME)自愿报告数据,为制定ME防范策略提供依据。方法:采用回顾性研究和描述性统计方法。分析ME的分级、分类、引发因素、引发人员的例次及其构成比。ME分级参照《中国用药错误管理专家共识》标准,分为4层9级。结果:共分析全国19个省市657家医疗机构的11 792例ME报告。ME分级中,未到达患者的内部差错(A级+B级)比例为80.05%;未给患者带来伤害的接近错误(第一层+第二层)比例达99.26%;第三层ME对患者造成一定伤害,占比0.74%;未收到第四层死亡报告。ME分类中,用量错误、品种错误、给药频次、数量和给药途径错误报告比例集中,5项累计构成比例达59.73%。ME引发因素中,人员因素和药品因素被报告者认为是引起差错的重要原因。其中音似形似药品引起的ME占到18.98%。ME引发人员中,由于监测网数据主要由药师报告,因此发现的医生ME最多,达60.95%,其次为药师34.57%,护士极少。结论:ME大数据一定程度上反映了我国用药安全的现状,尤其是医师处方和药师调剂这两个环节的真实情况。医疗机构应将信息化防范用药错误和持续的教育培训作为工作重点。 OBJECTIVE: To analyze voluntary reporting data of drug abuse (ME) in China’s clinical safety monitoring network to provide the basis for formulating ME prevention strategies. Methods: A retrospective study and descriptive statistics were used. Analysis of the classification of ME, classification, triggering factors, triggering cases and their constituent ratio. ME classification with reference to “Chinese medicine error management expert consensus” standard, divided into 4 layers 9. Results: A total of 11 792 ME reports from 657 medical institutions in 19 provinces and cities nationwide were analyzed. In the ME classification, the proportion of internal errors (A grade + B grade) that did not reach the patients was 80.05%; the percentage of the close errors (first + second) who did not cause harm to the patients reached 99.26%; the third ME The patient caused some injuries, accounting for 0.74%; did not receive the fourth floor of the death report. ME classification, the wrong dosage, variety error, dosage frequency, quantity and route of administration error reporting concentration, five cumulative composition ratio of 59.73%. Of the ME triggers, personnel and pharmaceutical factors were reported by the reporters as a significant cause of errors. One of the sound-like drugs caused by ME accounted for 18.98%. Among the ME-induced personnel, since the data of the monitoring network were mainly reported by the pharmacists, the doctors ME found were up to 60.95%, followed by pharmacists by 34.57%, with very few nurses. Conclusion: The big data of ME, to a certain extent, reflects the current status of drug safety in our country, especially the real situation of the two links of the doctor prescription and pharmacist adjustment. Medical institutions should take the information of prevention and treatment errors and continuing education and training as the focus of work.