Mir Caroline, Gadri Amina, Zelger Georges L, Pichon Renaud, Pannatier André
Pharmacie des Hôpitaux du Nord Vaudois et de la Broye (PHNVB), Entremonts 11, 1400, Yverdon-les-Bains, Switzerland.
Department of Pharmacy, University Hospital Lausanne, Lausanne, Switzerland.
Pharm World Sci. 2009 Oct;31(5):596-602. doi: 10.1007/s11096-009-9306-z. Epub 2009 Jun 25.
To assess the change in non-compliant items in prescription orders following the implementation of a computerized physician order entry (CPOE) system named PreDiMed.
The department of internal medicine (39 and 38 beds) in two regional hospitals in Canton Vaud, Switzerland.
The prescription lines in 100 pre- and 100 post-implementation patients' files were classified according to three modes of administration (medicines for oral or other non-parenteral uses; medicines administered parenterally or via nasogastric tube; pro re nata (PRN), as needed) and analyzed for a number of relevant variables constitutive of medical prescriptions.
The monitored variables depended on the pharmaceutical category and included mainly name of medicine, pharmaceutical form, posology and route of administration, diluting solution, flow rate and identification of prescriber.
In 2,099 prescription lines, the total number of non-compliant items was 2,265 before CPOE implementation, or 1.079 non-compliant items per line. Two-thirds of these were due to missing information, and the remaining third to incomplete information. In 2,074 prescription lines post-CPOE implementation, the number of non-compliant items had decreased to 221, or 0.107 non-compliant item per line, a dramatic 10-fold decrease (chi(2) = 4615; P < 10(-6)). Limitations of the computerized system were the risk for erroneous items in some non-prefilled fields and ambiguity due to a field with doses shown on commercial products.
The deployment of PreDiMed in two departments of internal medicine has led to a major improvement in formal aspects of physicians' prescriptions. Some limitations of the first version of PreDiMed were unveiled and are being corrected.
评估实施名为PreDiMed的计算机化医师医嘱录入（CPOE）系统后处方医嘱中不符合规定项目的变化情况。
瑞士沃州两家地区医院的内科（分别有39张和38张床位）。
根据三种给药方式（口服或其他非肠道给药的药物；肠道外给药或经鼻胃管给药的药物；按需给药，即PRN）对100例实施前和100例实施后患者档案中的处方行进行分类，并分析构成医学处方的一些相关变量。
监测变量取决于药物类别，主要包括药品名称、剂型、剂量和给药途径、稀释液、流速以及开处方者的标识。
在2099条处方行中，CPOE实施前不符合规定项目的总数为2265项，即每行1.079项不符合规定项目。其中三分之二是由于信息缺失，其余三分之一是由于信息不完整。CPOE实施后在2074条处方行中，不符合规定项目的数量降至221项，即每行0.107项不符合规定项目，下降了10倍之多（χ² = 4615；P < 10⁻⁶）。计算机系统的局限性在于一些未预填充字段中存在错误项目的风险，以及由于商业产品上显示剂量的字段存在歧义。
PreDiMed在两个内科科室的部署使医生处方的形式方面有了重大改进。PreDiMed第一版的一些局限性已被发现并正在纠正。
