Eslami Saeid, Abu-Hanna Ameen, de Keizer Nicolette F, de Jonge Evert
Department of Medical Informatics, Academic Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands.
Drug Saf. 2006;29(9):803-9. doi: 10.2165/00002018-200629090-00004.
Medication errors, and the resultant adverse drug events (ADEs), are one of the main preventable causes of morbidity and mortality. Computerised physician order entry (CPOE) is reported to reduce the frequency of these errors. However, CPOE systems themselves may be associated with errors. The aim of this study was to investigate the effects of a CPOE system that displays an initial default dose for gentamycin and tobramycin administration on the frequency of medication errors and potential ADEs in patients with renal insufficiency.
Gentamycin and tobramycin prescriptions from the CPOE records of a Dutch tertiary adult intensive care unit were retrospectively compared with doses recommended by a locally developed guideline. The default dose for gentamycin and tobramycin in the CPOE system is 240 mg/day. A dose prescribing error was defined as an administered dose that exceeded the recommended dose by >10%.
Three hundred and ninty two prescriptions, relating to 253 patients (of whom 184 had renal insufficiency), were analysed. There was a high frequency (58%, 227 of 392) of prescriptions that used the CPOE system's default dose of 240 mg/day. The dose was wrong in 73% (165) of these orders. Default orders for patients with renal insufficiency amounted to 52% (132 of 259). A total of 86% (113 of 132) of these resulted in potential ADEs compared with 53% (66 of 124) for the rest of orders (p < 0.0001).
A markedly high frequency of prescriptions followed the default dose value and, in patients with renal insufficiency, there was a high frequency of doses exceeding the guideline recommendation (+10%), amounting to potential ADEs.
Initial CPOE dose values for prescribing gentamycin and tobramycin, which are based on a fixed default value, form a source of potential ADEs for patients with renal insufficiency.
用药错误以及由此导致的药物不良事件（ADEs）是发病率和死亡率的主要可预防原因之一。据报道，计算机化医生医嘱录入系统（CPOE）可减少这些错误的发生频率。然而，CPOE系统本身可能也会出现错误。本研究的目的是调查一种在庆大霉素和妥布霉素给药时显示初始默认剂量的CPOE系统对肾功能不全患者用药错误频率和潜在药物不良事件的影响。
回顾性比较荷兰一家三级成人重症监护病房CPOE记录中的庆大霉素和妥布霉素处方与当地制定的指南推荐剂量。CPOE系统中庆大霉素和妥布霉素的默认剂量为240毫克/天。剂量处方错误定义为给药剂量超过推荐剂量>10%。
分析了与253例患者（其中184例肾功能不全）相关的392份处方。使用CPOE系统默认剂量240毫克/天的处方频率很高（58%，392份中的227份）。这些医嘱中有73%（165份）的剂量有误。肾功能不全患者的默认医嘱占52%（259份中的132份）。这些医嘱中有86%（132份中的113份）导致了潜在的药物不良事件，其余医嘱的这一比例为53%（124份中的66份）（p<0.0001）。
遵循默认剂量值的处方频率明显很高，在肾功能不全患者中，超过指南推荐剂量（+10%）的剂量频率很高，这相当于潜在的药物不良事件。
基于固定默认值开具庆大霉素和妥布霉素的CPOE初始剂量值是肾功能不全患者潜在药物不良事件的一个来源。
