Abboud Patricia A, Ancheta Rose, McKibben Michael, Jacobs Brian R
Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Health Informatics J. 2006 Sep;12(3):187-98. doi: 10.1177/1460458206066654.
Computerized provider order entry (CPOE) and clinical decision support improve medication prescribing safety in adults. However, effective therapy for children requires dosing based on circulating medication levels. We examined the introduction of a computerized corollary order for aminoglycoside blood level monitoring. The study was divided into baseline (BP) and corollary order (CP) periods. In the CP, we implemented a workflow-integrated reminder to order blood levels and presented this to the clinician during each aminoglycoside ordering session. Appropriate laboratory monitoring was 128/159 (80.5%) courses in the BP and 146/177 (82.5%) courses in the CP. Thus introduction of the order did not significantly improve laboratory monitoring rates, nor did it result in a reduction in the rate of either toxic or subtherapeutic levels. However, aminoglycoside corollary orders may have an important role in institutions where pharmacists are not actively involved in monitoring therapy.
计算机医嘱录入（CPOE）和临床决策支持可提高成人用药处方的安全性。然而，儿童的有效治疗需要根据循环药物水平进行给药。我们研究了引入氨基糖苷类血药浓度监测的计算机辅助医嘱。该研究分为基线期（BP）和辅助医嘱期（CP）。在CP期，我们实施了工作流程整合提醒，以便在每次氨基糖苷类药物开方时向临床医生提示进行血药浓度检测。适当的实验室监测在BP期为128/159（80.5%）疗程，在CP期为146/177（82.5%）疗程。因此，引入该医嘱并未显著提高实验室监测率，也未降低中毒或治疗不足水平的发生率。然而，在药剂师未积极参与监测治疗的机构中，氨基糖苷类辅助医嘱可能具有重要作用。
