Bates D W, Teich J M, Lee J, Seger D, Kuperman G J, Ma'Luf N, Boyle D, Leape L
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
J Am Med Inform Assoc. 1999 Jul-Aug;6(4):313-21. doi: 10.1136/jamia.1999.00660313.
Medication errors are common, and while most such errors have little potential for harm they cause substantial extra work in hospitals. A small proportion do have the potential to cause injury, and some cause preventable adverse drug events.
To evaluate the impact of computerized physician order entry (POE) with decision support in reducing the number of medication errors.
Prospective time series analysis, with four periods.
All patients admitted to three medical units were studied for seven to ten-week periods in four different years. The baseline period was before implementation of POE, and the remaining three were after. Sophistication of POE increased with each successive period.
Physician order entry with decision support features such as drug allergy and drug-drug interaction warnings.
Medication errors, excluding missed dose errors.
During the study, the non-missed-dose medication error rate fell 81 percent, from 142 per 1,000 patient-days in the baseline period to 26.6 per 1,000 patient-days in the final period (P < 0.0001). Non-intercepted serious medication errors (those with the potential to cause injury) fell 86 percent from baseline to period 3, the final period (P = 0.0003). Large differences were seen for all main types of medication errors: dose errors, frequency errors, route errors, substitution errors, and allergies. For example, in the baseline period there were ten allergy errors, but only two in the following three periods combined (P < 0.0001).
Computerized POE substantially decreased the rate of non-missed-dose medication errors. A major reduction in errors was achieved with the initial version of the system, and further reductions were found with addition of decision support features.
用药错误很常见，虽然大多数此类错误造成伤害的可能性很小，但它们在医院中会导致大量额外工作。一小部分确实有可能造成伤害，还有一些会导致可预防的药物不良事件。
评估具有决策支持功能的计算机化医生医嘱录入（POE）在减少用药错误数量方面的影响。
前瞻性时间序列分析，分为四个阶段。
对三个内科病房收治的所有患者在四个不同年份进行了为期七至十周的研究。基线期是在POE实施之前，其余三个阶段是在实施之后。POE的复杂性随着每个连续阶段而增加。
具有药物过敏和药物相互作用警告等决策支持功能的医生医嘱录入。
用药错误，不包括漏服剂量错误。
在研究期间，非漏服剂量的用药错误率下降了81%，从基线期的每1000患者日142例降至最后阶段的每1000患者日26.6例（P < 0.0001）。未被拦截的严重用药错误（有可能造成伤害的错误）从基线期到第三阶段（最后阶段）下降了86%（P = 0.0003）。所有主要类型的用药错误都有很大差异：剂量错误、频率错误、给药途径错误、替代错误和过敏。例如，在基线期有10例过敏错误，但在随后的三个阶段中总共只有2例（P < 0.0001）。
计算机化的POE显著降低了非漏服剂量的用药错误率。该系统的初始版本实现了错误的大幅减少，增加决策支持功能后又进一步减少了错误。
