Gandhi Tejal K, Weingart Saul N, Seger Andrew C, Borus Joshua, Burdick Elisabeth, Poon Eric G, Leape Lucian L, Bates David W
Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA 02120, USA.
J Gen Intern Med. 2005 Sep;20(9):837-41. doi: 10.1111/j.1525-1497.2005.0194.x.
Medication errors are common among inpatients and many are preventable with computerized prescribing. Relatively little is known about outpatient prescribing errors or the impact of computerized prescribing in this setting.
To assess the rates, types, and severity of outpatient prescribing errors and understand the potential impact of computerized prescribing.
Prospective cohort study in 4 adult primary care practices in Boston using prescription review, patient survey, and chart review to identify medication errors, potential adverse drug events (ADEs) and preventable ADEs.
Outpatients over age 18 who received a prescription from 24 participating physicians.
We screened 1879 prescriptions from 1202 patients, and completed 661 surveys (response rate 55%). Of the prescriptions, 143 (7.6%; 95% confidence interval (CI) 6.4% to 8.8%) contained a prescribing error. Three errors led to preventable ADEs and 62 (43%; 3% of all prescriptions) had potential for patient injury (potential ADEs); 1 was potentially life-threatening (2%) and 15 were serious (24%). Errors in frequency (n=77, 54%) and dose (n=26, 18%) were common. The rates of medication errors and potential ADEs were not significantly different at basic computerized prescribing sites (4.3% vs 11.0%, P=.31; 2.6% vs 4.0%, P=.16) compared to handwritten sites. Advanced checks (including dose and frequency checking) could have prevented 95% of potential ADEs.
Prescribing errors occurred in 7.6% of outpatient prescriptions and many could have harmed patients. Basic computerized prescribing systems may not be adequate to reduce errors. More advanced systems with dose and frequency checking are likely needed to prevent potentially harmful errors.
用药错误在住院患者中很常见，许多用药错误可通过计算机化处方得以预防。对于门诊处方错误或计算机化处方在此环境中的影响，人们了解得相对较少。
评估门诊处方错误的发生率、类型和严重程度，并了解计算机化处方的潜在影响。
在波士顿的4家成人初级保健机构进行前瞻性队列研究，采用处方审查、患者调查和病历审查来识别用药错误、潜在药物不良事件（ADE）和可预防的ADE。
年龄在18岁以上、从24位参与研究的医生处获得处方的门诊患者。
我们筛查了1202名患者的1879张处方，并完成了661份调查（回复率55%）。在这些处方中，143张（7.6%；95%置信区间[CI] 6.4%至8.8%）包含处方错误。3个错误导致了可预防的ADE，62个（43%；占所有处方的3%）有导致患者受伤的可能性（潜在ADE）；1个可能危及生命（2%），15个严重（24%）。频次错误（n = 77，54%）和剂量错误（n = 26，18%）很常见。与手写处方的机构相比，基本计算机化处方机构的用药错误率和潜在ADE发生率没有显著差异（4.3%对11.0%，P = 0.31；2.6%对4.0%，P = 0.16）。高级检查（包括剂量和频次检查）本可预防95%的潜在ADE。
7.6%的门诊处方存在处方错误，许多错误可能对患者造成伤害。基本的计算机化处方系统可能不足以减少错误。可能需要更先进的、带有剂量和频次检查功能的系统来预防潜在的有害错误。
