Department of Hospital Pharmacy, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands.
Int J Med Inform. 2010 May;79(5):361-9. doi: 10.1016/j.ijmedinf.2010.01.008. Epub 2010 Feb 19.
To study correctness of drug safety alert handling and error type in a computerized physician order entry (CPOE) system in a simulated work environment.
Disguised observation study of 18 physicians (12 from internal medicine and 6 from surgery) entering 35 orders of predefined patient cases with 13 different drug safety alerts in a CPOE. Structured interviews about how the generated drug safety alerts were handled in the simulation test and resemblance of the test to the normal work environment. Handling and reasons for this were scored for correctness and error type.
Thirty percent of alerts were handled incorrectly, because the action itself and/or the reason for the handling were incorrect. Sixty-three percent of the errors were categorized as rule based and residents in surgery used incorrect justifications twice as often as residents in internal medicine. They often referred to monitoring of incorrect substances or parameters. One alert presented as a second alert in one screen was unconsciously overridden several times. One quarter of residents showed signs of alert fatigue.
Although alerts were mainly handled correctly, underlying rules and reasoning were often incorrect, thereby threatening patient safety. This study gave an insight into the factors playing a role in incorrect drug safety alert handling that should be studied in more detail. The results suggest that better training, improved concise alert texts, and increased specificity might help. Furthermore, the safety of the predefined override reason 'will monitor' and double alert presentation in one screen is questioned.
在模拟工作环境中，研究计算机化医师医嘱录入（CPOE）系统中药物安全警报处理的正确性和错误类型。
对 18 名医师（内科 12 名，外科 6 名）进行伪装观察研究，他们在 CPOE 中输入了 35 个预定患者病例的医嘱，其中有 13 种不同的药物安全警报。对生成的药物安全警报在模拟测试中是如何处理的以及测试与正常工作环境的相似性进行了结构化访谈。处理方式和原因被记录下来，以便评估其正确性和错误类型。
30%的警报处理不正确，因为处理本身和/或处理的原因是错误的。63%的错误被归类为基于规则的错误，外科住院医师使用不正确的理由的频率是内科住院医师的两倍。他们经常提到对不正确物质或参数的监测。一个在一个屏幕上显示为第二个警报的警报被无意识地多次忽略。四分之一的住院医师表现出警报疲劳的迹象。
尽管警报主要处理正确，但潜在的规则和推理经常是错误的，从而威胁到患者的安全。本研究深入了解了导致药物安全警报处理不正确的因素，这些因素需要进一步研究。结果表明，更好的培训、更简洁的警报文本和提高的特异性可能会有所帮助。此外，“将监测”和在一个屏幕上显示双重警报的预定义忽略原因的安全性受到质疑。
