基于电子临床决策支持系统的个人干预预防重症监护患者的药物不良反应。
Prevention of adverse drug reactions in intensive care patients by personal intervention based on an electronic clinical decision support system.
机构信息
Department of Internal Medicine VI (Clinical Pharmacology and Pharmacoepidemiology), University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
出版信息
Intensive Care Med. 2010 Apr;36(4):665-72. doi: 10.1007/s00134-010-1778-8. Epub 2010 Feb 9.
OBJECTIVE
We investigated the effect of written drug information for senior clinicians on the incidence of drug-drug interactions (DDIs) and DDI-related adverse events in intensive care patients.
DESIGN AND METHODS
A prospective controlled intervention cohort study was conducted in a medical intensive and intermediate care unit in a university hospital. From 1,062 consecutive intensive care patients, those 265 (control: 136, intervention: 129) with > or =8 concurrently prescribed drugs were included in the study (to include high-risk patients with polypharmacy). The DDI information for senior clinicians during an intervention period of 3 months was based on a computerised clinical decision support system (CDSS) containing information on risk and management of 9,453 drug combinations.
RESULTS
The number of patients with at least one DDI at the end of the respective study phase decreased by 18% (relative risk reduction) from 90 (66%) patients in controls to 70 (54%) in the intervention group (p = 0.02). The relative risk of a patient suffering from at least one DDI-related adverse event decreased by 43% from 60 (44%) patients in controls to 32 (25%) in the intervention group (p < 0.01). Among these events, the incidence of QT(C) prolongation was reduced by 64% from 15 (11%) patients in the control group to 5 (4%) in the intervention group (p = 0.04), and the incidence of hypokalemia by 80% from 14 (10%) to 2 (2%, p < 0.01).
CONCLUSION
Written drug information based on a CDSS considerably decreased DDIs and DDI-related adverse events in routine practice.
目的
我们研究了为资深临床医生提供书面药物信息对重症监护患者药物-药物相互作用（DDI）和 DDI 相关不良事件发生率的影响。
设计和方法
在一家大学医院的内科重症监护病房和中级护理病房进行了前瞻性对照干预队列研究。从 1062 例连续重症监护患者中，纳入了 265 例（对照组 136 例，干预组 129 例）同时服用 > 或 =8 种药物的患者（包括服用多种药物的高危患者）。在 3 个月的干预期间，为资深临床医生提供基于计算机化临床决策支持系统（CDSS）的 DDI 信息，该系统包含了 9453 种药物组合的风险和管理信息。
结果
在各自的研究阶段结束时，至少有一种 DDI 的患者数量从对照组的 90 例（66%）减少到干预组的 70 例（54%），减少了 18%（相对风险降低）（p = 0.02）。至少有一种 DDI 相关不良事件的患者的相对风险从对照组的 60 例（44%）降低到干预组的 32 例（25%），降低了 43%（p < 0.01）。在这些事件中，QT(C)延长的发生率从对照组的 15 例（11%）降低到干预组的 5 例（4%），降低了 64%（p = 0.04），低钾血症的发生率从对照组的 14 例（10%）降低到干预组的 2 例（2%），降低了 80%（p < 0.01）。
结论
基于 CDSS 的书面药物信息在常规实践中大大减少了 DDI 和 DDI 相关不良事件的发生。
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