Weingart Saul N, Simchowitz Brett, Shiman Lawrence, Brouillard Daniela, Cyrulik Adrienne, Davis Roger B, Isaac Thomas, Massagli Michael, Morway Laurinda, Sands Daniel Z, Spencer Justin, Weissman Joel S
Center for Patient Safety, Dana-Farber Cancer Institute, 44 Binney St, Boston, MA 02115, USA.
Arch Intern Med. 2009 Sep 28;169(17):1627-32. doi: 10.1001/archinternmed.2009.300.
While electronic prescribing (e-prescribing) systems with drug interaction and allergy alerts promise to improve medication safety in ambulatory care, clinicians often override these safety features. We undertook a study of respondents' satisfaction with e-prescribing systems, their perceptions of alerts, and their perceptions of behavior changes resulting from alerts.
Random sample survey of 300 Massachusetts ambulatory care clinicians who used a commercial e-prescribing system.
A total of 184 respondents completed the survey (61%). Respondents indicated that e-prescribing improved the quality of care delivered (78%), prevented medical errors (83%), and enhanced patient satisfaction (71%) and clinician efficiency (75%). In addition, 35% of prescribers said that electronic alerts caused them to modify a potentially dangerous prescription in the last 30 days. They suggested that alerts also led to other changes in clinical care: counseling patients about potential reactions (49% of respondents), looking up information in medical references (44%), and changing the way a patient was monitored (33%). Altogether, 63% of clinicians reported taking action other than discontinuing or modifying an alerted prescription in the previous month in response to alerts. Despite these benefits, fewer than half of respondents were satisfied with drug interaction and allergy alerts (47%). Problems included alerts triggered by discontinued medications (58%), alerts that failed to account for appropriate drug combinations (46%), and excessive volume of alerts (37%).
Although clinicians were critical of the quality of e-prescribing alerts, alerts may lead to clinically significant modifications in patient management not readily apparent based on "acceptance" rates.
虽然具有药物相互作用和过敏警报功能的电子处方（e-prescribing）系统有望提高门诊医疗中的用药安全性，但临床医生常常会忽略这些安全功能。我们开展了一项研究，调查受访者对电子处方系统的满意度、他们对警报的看法以及他们对警报导致的行为变化的看法。
对300名使用商业电子处方系统的马萨诸塞州门诊医疗临床医生进行随机抽样调查。
共有184名受访者完成了调查（61%）。受访者表示，电子处方提高了所提供医疗服务的质量（78%），预防了医疗差错（83%），提高了患者满意度（71%）和临床医生效率（75%）。此外，35%的开处方者表示，在过去30天里，电子警报使他们修改了一份有潜在危险的处方。他们认为，警报还导致了临床护理方面的其他变化：就潜在反应向患者提供咨询（49%的受访者）、查阅医学参考文献中的信息（44%）以及改变对患者的监测方式（33%）。总体而言，63%的临床医生报告称，上个月除了停止或修改警报处方外，还针对警报采取了其他行动。尽管有这些好处，但不到一半的受访者对药物相互作用和过敏警报感到满意（47%）。问题包括由已停用药物触发的警报（58%）、未考虑适当药物组合的警报（46%）以及警报过多（37%）。
虽然临床医生对电子处方警报的质量持批评态度，但警报可能会导致患者管理方面具有临床意义的改变，而这些改变基于“接受”率并不容易显现出来。
