Mahoney Charles D, Berard-Collins Christine M, Coleman Reid, Amaral Joseph F, Cotter Carole M
Pharmacy and Cancer Services, Rhode Island Hospital, Providence 02903, USA.
Am J Health Syst Pharm. 2007 Sep 15;64(18):1969-77. doi: 10.2146/ajhp060617.
The implementation of vendor-based integrated clinical information technology was studied, and its effect on medication errors throughout the medication-use process in a health care system was evaluated.
The integrated systems selected for implementation included computerized physician order entry, pharmacy and laboratory information systems, clinical decision-support systems (CDSSs), electronic drug dispensing systems (EDDSs), and a bar-code point-of-care medication administration system. The primary endpoint was the reduction in related medication errors. Secondary endpoints included the reductions in medication order turnaround time and EDDS override transactions.
Integrated clinical information system technology was implemented in a multihospital health care system with a phased-in approach. A positive effect of this integration on medication errors throughout the medication-use process was demonstrated. Most prescribing errors decreased significantly in the selected categories monitored, specifically drug allergy detection, excessive dosing, and incomplete or unclear orders. Pharmacists were also twice as likely to identify dosages requiring adjustment for renal insufficiency when the integrated technology was in place and more than six times as likely for drug levels outside of the therapeutic range. A positive effect on medication administration safety was also demonstrated: 73 administration-related errors were intercepted through electronic bar-code scanning for every 100,000 doses charted.
Integration of clinical information system technology decreased selected types of medication errors throughout the medication-use process in a health care system and improved therapeutic drug monitoring in patients with renal insufficiency and in patients receiving drugs with narrow therapeutic ranges through the use of CDSS alerts.
研究基于供应商的综合临床信息技术的实施情况，并评估其对医疗保健系统中整个用药过程用药错误的影响。
选择实施的综合系统包括计算机化医生医嘱录入系统、药房和实验室信息系统、临床决策支持系统（CDSS）、电子药品调配系统（EDDS）以及床边条形码用药管理系统。主要终点是相关用药错误的减少。次要终点包括用药医嘱周转时间和EDDS超控交易的减少。
综合临床信息系统技术在一个多医院医疗保健系统中采用分阶段方式实施。证明了这种整合对整个用药过程用药错误有积极影响。在所监测的选定类别中，大多数处方错误显著减少，特别是药物过敏检测、过量用药以及不完整或不清楚的医嘱。当综合技术到位时，药剂师识别需要因肾功能不全调整剂量的可能性增加了一倍，识别治疗范围外药物水平的可能性增加了六倍多。还证明了对用药管理安全有积极影响：每100,000剂记录的用药中，通过电子条形码扫描拦截了73次与用药管理相关的错误。
临床信息系统技术的整合减少了医疗保健系统中整个用药过程选定类型的用药错误，并通过使用CDSS警报改善了肾功能不全患者和接受治疗范围窄的药物患者的治疗药物监测。
