Mirco Ana, Campos Luís, Falcão Fátima, Nunes João Silva, Aleixo Ana
Hospital de S. Francisco Xavier, Serviços Farmacêuticos, Estrada do Forte do Alto do Duque, Lisboa, Portugal.
Pharm World Sci. 2005 Aug;27(4):351-2. doi: 10.1007/s11096-005-2452-z.
Evaluation of a computerized physician order entry in an Internal Medicine Department, with a unit-dose distribution system.
Pharmacy Department, Internal Medicine Department. S. Francisco Xavier Hospital, Lisbon, Portugal.
This study was carried out in December 2001 and January 2002. After two years experience of the CPOE system, medication errors were evaluated prospectively, in an internal medical department of a 360-bed academic hospital. Data were collected once a week. Pharmacists reviewed all medical prescriptions as part of their routine work. Medication errors detected were recorded on a data collection form with a design based on the types of errors as defined by the American Society of Hospital Pharmacists (ASHP). Completed forms were reviewed and medication errors were classed according to ASHP guidelines.
A total of 2268 orders were monitored (162 patients). In these orders, 73 medication errors (22.4% of the patients) were detected and documented (59 prescribing errors and 14 monitoring errors). The most common prescribing errors were deficiencies related to the right class but wrong drug (28.3%): omeprazole vs. ranitidine/sucralfate in stress ulcer prophylaxis; incorrect dose (30%) and unclear orders (13.3%). Errors related to incorrect frequency of administration (5%); maintenance of IV route (5%); duplicated drug therapy (11.7%); drug interactions (1.7%) and length of therapy (3.3%) were also detected. The 14 monitoring errors detected were failures to review a prescribed regimen for appropriateness and detection of problems.
Computerized prescription order entry has demonstrated effectiveness in eliminating medication errors related to transcribing and patient identification. Nevertheless, medication errors related to prescription and monitoring still occur. The use of clinical decision support systems and pharmacist involvement is vital to achieve maximum medication safety and reduce medication error rates.
评估内科采用单剂量配药系统的计算机医嘱录入情况。
葡萄牙里斯本圣弗朗西斯科·泽维尔医院内科药房。
本研究于2001年12月和2002年1月进行。在计算机医嘱录入系统使用两年后，对一家拥有360张床位的教学医院内科的用药错误进行前瞻性评估。每周收集一次数据。药剂师在日常工作中审核所有医疗处方。检测到的用药错误记录在一份数据收集表上，该表的设计基于美国医院药师协会（ASHP）定义的错误类型。对填好的表格进行审核，并根据ASHP指南对用药错误进行分类。
共监测了2268条医嘱（涉及162名患者）。在这些医嘱中，检测到并记录了73例用药错误（占患者的22.4%）（59例处方错误和14例监测错误）。最常见的处方错误是类别正确但药物错误（28.3%）：预防应激性溃疡时奥美拉唑与雷尼替丁/硫糖铝；剂量错误（30%）和医嘱不明确（13.3%）。还检测到给药频率错误（5%）；静脉途径维持错误（5%）；重复药物治疗（11.7%）；药物相互作用（1.7%）和治疗时长错误（3.3%）。检测到的14例监测错误是未能审核规定治疗方案的适宜性并发现问题。
计算机处方录入已证明在消除与抄写和患者识别相关的用药错误方面有效。然而，与处方和监测相关的用药错误仍然存在。使用临床决策支持系统和药剂师参与对于实现最大程度的用药安全和降低用药错误率至关重要。
