Soper Juliet, Chan George T C, Skinner Jonathan R, Spinetto Heather D, Gentles Thomas L
Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.
Cardiol Young. 2006 Jun;16(3):256-60. doi: 10.1017/S1047951106000333.
To assess the impact of a computerised system to support decision-making concerning the management of warfarin used in maintenance of anti-coagulation.
Retrospective case series study comparing manual and computerised records of prescribing.
A tertiary paediatric cardiology department in a teaching hospital.
The 26 children receiving warfarin to maintain anticoagulation at the time of introduction of a computerised system to support decision-making.
A rules-based computerised system to support decisions, based on existing departmental guidelines, for management of anticoagulation using warfarin was introduced to aid prescribing physicians.
We assessed the stability of the International Normalised Ratio, along with the number of checks made of the ratio, and the adjustments of dosage. Dosages, and recheck interval prescriptions, were compared to the guidelines established by our department.
We compared 274 prescriptions made manually, and 608 made using the computerised system to support decision-making, covering periods of 4, and 11, months respectively. The mean proportion of time spent by the patients within their target range for the International ratio was maintained during the period studied, at 76 percent versus 79 percent (p = 0.79). The median number of checks of the ratio made for each patient over a period of 28 days was unchanged, at 1.9 versus 2.1 (p = 0.58). There was a significant change in prescribing practices, which more closely followed the departmental guidelines.
The introduction of a computerised system to support decision-making maintained the stability of the International ratio using warfarin, without increasing the number of checks or adjustments of dosages, in a point-of-care service for anticoagulation in children.
评估一个计算机系统对维持抗凝治疗中使用华法林管理决策的支持作用。
回顾性病例系列研究，比较手工和计算机化的处方记录。
一家教学医院的三级儿科心脏病科。
在引入支持决策的计算机系统时，正在接受华法林维持抗凝治疗的26名儿童。
引入一个基于规则的计算机系统，根据现有的科室指南，辅助开具处方的医生对华法林抗凝治疗进行决策。
我们评估了国际标准化比值（INR）的稳定性、对该比值的检查次数以及剂量调整情况。将剂量和复查间隔处方与我们科室制定的指南进行比较。
我们比较了分别为期4个月和11个月的274份手工开具的处方和608份使用支持决策的计算机系统开具的处方。在研究期间，患者INR处于目标范围内的平均时间比例保持稳定，分别为76%和79%（p = 0.79）。每位患者在28天内对INR的检查中位数没有变化，分别为1.9次和2.1次（p = 0.58）。处方实践有显著变化，更符合科室指南。
在儿童抗凝的即时护理服务中，引入支持决策的计算机系统可维持使用华法林时INR的稳定性，且不会增加检查次数或剂量调整次数。
