Shamliyan Tatyana A, Duval Sue, Du Jing, Kane Robert L
Division of Health Policy and Management, University of Minnesota School of Public Health, MMC 729, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
Health Serv Res. 2008 Feb;43(1 Pt 1):32-53. doi: 10.1111/j.1475-6773.2007.00751.x.
To examine the association between computerization of physician orders and prescribing medication errors. Data Sources. Studies published in English language were identified through MEDLINE (1990 through December 2005), Cochrane Central Register of Controlled Trials, and bibliographies of retrieved articles. Of 252 identified in the search, 12 (4.8 percent) original investigations that compared rates of prescribing medication errors with handwritten and computerized physician orders were included.
Information on study design, participant characteristics, clinical settings, and outcomes rates were abstracted independently by two investigators using a standardized protocol.
Compared with handwritten orders, 80 percent of studies (8/10 studies) reported a significant reduction in total prescribing errors, 43 percent in dosing errors (3/7 studies), and 37.5 percent in adverse drug events (3/8 studies). The use of computerized orders was associated with a 66 percent reduction in total prescribing errors in adults (odds ratio [OR]=0.34; 95 percent confidence interval [CI] 0.22-0.52) and a positive tendency in children (p for interaction=.028). The benefit of computerized orders was larger when the rate of errors was more than 12 percent with handwritten orders (p for interaction=.022). Significant heterogeneity in the results compromised pooled relative risks. One randomized controlled intervention demonstrated the greatest benefits of computerized orders on total prescribing errors (OR=0.02, 95 percent CI 0.01-0.02) and dosing errors (OR=0.28; 95 percent CI 0.15-0.52) with 775 avoided prescribing errors (95 percent CI 752-811) per 1,000 orders in a pediatric hospital.
Computerization of physicians' orders shows great promise. It will be more effective when linked to other computerized systems to detect and prevent prescribing errors.
研究医嘱电子化与处方用药错误之间的关联。数据来源。通过MEDLINE（1990年至2005年12月）、Cochrane对照试验中心注册库以及检索文章的参考文献，识别以英文发表的研究。在检索到的252项研究中，纳入了12项（4.8%）将手写医嘱和电子医嘱的处方用药错误率进行比较的原始调查。
两名研究人员使用标准化方案独立提取有关研究设计、参与者特征、临床环境和结局发生率的信息。
与手写医嘱相比，80%的研究（10项研究中的8项）报告称处方总错误显著减少，剂量错误减少43%（7项研究中的3项），药物不良事件减少37.5%（8项研究中的3项）。电子医嘱的使用与成人处方总错误减少66%相关（优势比[OR]=0.34；95%置信区间[CI]0.22 - 0.52），在儿童中呈正向趋势（交互作用p值=0.028）。当手写医嘱错误率超过12%时，电子医嘱的益处更大（交互作用p值=0.022）。结果存在显著异质性，影响了合并相对风险。一项随机对照干预显示，电子医嘱在处方总错误（OR=0.02，95%CI 0.01 - 0.02）和剂量错误（OR=0.28；95%CI 0.15 - 0.52）方面益处最大，在一家儿科医院每1000条医嘱可避免775例处方错误（95%CI 752 - 811）。
医嘱电子化前景广阔。与其他计算机系统连接以检测和预防处方错误时，将更有效。
