Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle, Washington 98195-7630, USA.
J Am Med Inform Assoc. 2010 Jan-Feb;17(1):78-84. doi: 10.1197/jamia.M3285.
Computerized provider order entry (CPOE) has been shown to improve patient safety by reducing medication errors and subsequent adverse drug events (ADEs). Studies demonstrating these benefits have been conducted primarily in the inpatient setting, with fewer in the ambulatory setting. The objective was to evaluate the effect of a basic, ambulatory CPOE system on medication errors and associated ADEs.
This quasiexperimental, pretest-post-test study was conducted in a community-based, multispecialty health system not affiliated with an academic medical center. The intervention was a basic CPOE system with limited clinical decision support capabilities.
Comparison of prescriptions written before (n=5016 handwritten) to after (n=5153 electronically prescribed) implementation of the CPOE system. The primary outcome was the occurrence of error(s); secondary outcomes were types and severity of errors.
Frequency of errors declined from 18.2% to 8.2%-a reduction in adjusted odds of 70% (OR: 0.30; 95% CI 0.23 to 0.40). The largest reductions were seen in adjusted odds of errors of illegibility (97%), use of inappropriate abbreviations (94%) and missing information (85%). There was a 57% reduction in adjusted odds of errors that did not cause harm (potential ADEs) (OR 0.43; 95% CI 0.38 to 0.49). The reduction in the number of errors that caused harm (preventable ADEs) was not statistically significant, perhaps due to few errors in this category.
A basic CPOE system in a community setting was associated with a significant reduction in medication errors of most types and severity levels.
计算机化医嘱录入（CPOE）已被证明通过减少用药错误和随后的药物不良事件（ADE）来提高患者安全性。进行这些研究的主要是住院环境，而在门诊环境中进行的研究较少。目的是评估基本的门诊 CPOE 系统对用药错误和相关 ADE 的影响。
这是一项在社区为基础、多专科卫生系统进行的准实验性、前后测试研究，与学术医疗中心无关。干预措施是一个基本的 CPOE 系统，具有有限的临床决策支持功能。
在实施 CPOE 系统之前（手写处方 5016 份）和之后（电子处方 5153 份）比较处方。主要结果是出现错误；次要结果是错误的类型和严重程度。
错误频率从 18.2%降至 8.2%，经调整的优势比（OR）降低了 70%（OR：0.30；95%置信区间 0.23 至 0.40）。最大的降幅见于字迹不清（97%）、使用不适当缩写（94%）和信息缺失（85%）错误的调整后的优势比。未造成伤害（潜在 ADE）的错误的调整后的优势比降低了 57%（OR 0.43；95%置信区间 0.38 至 0.49）。未造成伤害的错误数量（可预防 ADE）的减少没有统计学意义，可能是因为此类错误较少。
在社区环境中，基本的 CPOE 系统与大多数类型和严重程度的用药错误显著减少相关。
