Taylor James A, Loan Lori A, Kamara Judy, Blackburn Susan, Whitney Donna
Department of Pediatrics, University of Washington, Box 354920, Seattle, WA 98195, USA.
Pediatrics. 2008 Jan;121(1):123-8. doi: 10.1542/peds.2007-0919.
The goal was to determine whether implementation of a computerized physician order entry system was associated with a decrease in medication administration variances in a NICU.
A prospective observational study was conducted. Research nurses recorded details of medication administrations for patients in a NICU during standardized observation periods. Details of each administration were compared with the medication order; a variance was defined as a discrepancy between the order and the medication administration. Rates of variances before and after implementation of computerized physician order entry in the NICU were compared. Specific types of and reasons for variances were also compared.
Data on 526 medication administrations, including 254 during the pre-computerized physician order entry period and 272 after implementation of computerized physician order entry, were collected. Medication variances were detected for 19.8% of administrations during the pre-computerized physician order entry period, compared with 11.6% with computerized physician order entry (rate ratio: 0.53). Overall, administration mistakes, prescribing problems, and pharmacy problems accounted for 74% of medication variances; there were no statistically significant differences in rates for any of these specific reasons before versus after introduction of computerized physician order entry. Administration of a medication at the wrong time accounted for 53.1% of all variances. Variance rates related to giving a drug at the wrong time were significantly lower in the computerized physician order entry period than in the pre-computerized physician order entry period (rates: 6.7% and 9.9%, respectively; rate ratio: 0.53).
Implementation of computerized physician order entry in a NICU was associated with a significant decrease in the rate of medication administration variances. However, even with the use of computerized physician order entry, variances were noted for >11% of all medication administrations, which suggests that additional methods may be needed to improve neonatal patient safety.
确定实施计算机化医生医嘱录入系统是否与新生儿重症监护病房（NICU）用药差异的减少相关。
进行了一项前瞻性观察性研究。研究护士在标准化观察期内记录了NICU患者的用药详情。将每次用药的详情与医嘱进行比较；差异被定义为医嘱与用药之间的不符。比较了NICU实施计算机化医生医嘱录入前后的差异率。还比较了差异的具体类型和原因。
收集了526次用药的数据，包括计算机化医生医嘱录入前的254次和实施计算机化医生医嘱录入后的272次。在计算机化医生医嘱录入前的时期，19.8%的用药存在差异，而在计算机化医生医嘱录入后为11.6%（率比：0.53）。总体而言，用药错误、处方问题和药房问题占用药差异的74%；在引入计算机化医生医嘱录入前后，这些具体原因的发生率在统计学上没有显著差异。用药时间错误占所有差异的53.1%。与用药时间错误相关的差异率在计算机化医生医嘱录入期显著低于计算机化医生医嘱录入前期（发生率分别为6.7%和9.9%；率比：0.53）。
NICU实施计算机化医生医嘱录入与用药差异率的显著降低相关。然而，即使使用了计算机化医生医嘱录入，超过11%的用药仍存在差异，这表明可能需要其他方法来提高新生儿患者的安全性。
