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儿科化疗中的差错减少:计算机化医嘱录入与失效模式及效应分析

Error reduction in pediatric chemotherapy: computerized order entry and failure modes and effects analysis.

作者信息

Kim George R, Chen Allen R, Arceci Robert J, Mitchell Sandra H, Kokoszka K Michelle, Daniel Denise, Lehmann Christoph U

机构信息

Division of Health Sciences Informatics, The Johns Hopkins School of Medicine, Baltimore, MD 21287-3200, USA.

出版信息

Arch Pediatr Adolesc Med. 2006 May;160(5):495-8. doi: 10.1001/archpedi.160.5.495.

Abstract

OBJECTIVE

To implement and evaluate the impact of computerized provider order entry (CPOE) on reducing ordering errors in pediatric chemotherapy.

DESIGN

Before-and-after study from 2001 to 2004.

SETTING

Pediatric Oncology in an academic medical center.

INTERVENTION

Implementation of a CPOE system guided by multidisciplinary failure modes and effects analysis into pediatric chemotherapy.

MAIN OUTCOME MEASURES

Completion data on chemotherapy steps of high morbidity/mortality potential if missed (as determined by attending oncologists) from 1259 pre-CPOE paper and 1116 post-CPOE pediatric chemotherapy orders.

RESULTS

After CPOE deployment, daily chemotherapy orders were less likely to have improper dosing (relative risk [RR], 0.26; 95% confidence interval [CI], 0.11-0.61), incorrect dosing calculations (RR, 0.09; 95% CI, 0.03-0.34), missing cumulative dose calculations (RR, 0.32; 95% CI, 0.14-0.77), and incomplete nursing checklists (RR, 0.51; 95% CI, 0.33-0.80). There was no difference in the likelihood of improper dosing on treatment plans and a higher likelihood of not matching medication orders to treatment plans (RR, 5.4; 95% CI, 3.1-9.5).

CONCLUSION

Failure modes and effects analysis-guided CPOE reduced ordering errors in pediatric chemotherapy and provided data for further improvements.

摘要

目的

实施并评估计算机化医嘱录入(CPOE)对减少儿科化疗医嘱错误的影响。

设计

2001年至2004年的前后对照研究。

地点

一所学术医疗中心的儿科肿瘤科。

干预措施

在多学科失效模式与效应分析的指导下,将CPOE系统应用于儿科化疗。

主要观察指标

1259份CPOE实施前纸质版和1116份CPOE实施后儿科化疗医嘱中,由主治肿瘤学家确定的若遗漏则具有高发病/死亡风险的化疗步骤的完成数据。

结果

CPOE系统部署后,每日化疗医嘱出现剂量不当(相对风险[RR],0.26;95%置信区间[CI],0.11 - 0.61)、剂量计算错误(RR,0.09;95% CI,0.03 - 0.34)、累计剂量计算缺失(RR,0.32;95% CI,0.14 - 0.77)以及护理清单不完整(RR,0.51;95% CI,0.33 - 0.80)的可能性降低。治疗计划中剂量不当的可能性没有差异,且药物医嘱与治疗计划不匹配的可能性更高(RR,5.4;95% CI,3.1 - 9.5)。

结论

失效模式与效应分析指导下的CPOE减少了儿科化疗中的医嘱错误,并为进一步改进提供了数据。

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