Kaushal Rainu, Kern Lisa M, Barrón Yolanda, Quaresimo Jill, Abramson Erika L
Department of Pediatrics, Weill Medical College of Cornell University, 402 East 67th Street, Room-LA-259, New York, NY 10065, USA.
J Gen Intern Med. 2010 Jun;25(6):530-6. doi: 10.1007/s11606-009-1238-8. Epub 2010 Feb 26.
Although electronic prescribing (e-prescribing) holds promise for preventing prescription errors in the ambulatory setting, research on its effectiveness is inconclusive.
To assess the impact of a stand-alone e-prescribing system on the rates and types of ambulatory prescribing errors.
DESIGN, PARTICIPANTS: Prospective, non-randomized study using pre-post design of 15 providers who adopted e-prescribing with concurrent controls of 15 paper-based providers from September 2005 through June 2007.
Use of a commercial, stand-alone e-prescribing system with clinical decision support including dosing recommendations and checks for drug-allergy interactions, drug-drug interactions, and duplicate therapies.
Prescribing errors were identified by a standardized prescription and chart review.
We analyzed 3684 paper-based prescriptions at baseline and 3848 paper-based and electronic prescriptions at one year of follow-up. For e-prescribing adopters, error rates decreased nearly sevenfold, from 42.5 per 100 prescriptions (95% confidence interval (CI), 36.7-49.3) at baseline to 6.6 per 100 prescriptions (95% CI, 5.1-8.3) one year after adoption (p < 0.001). For non-adopters, error rates remained high at 37.3 per 100 prescriptions (95% CI, 27.6-50.2) at baseline and 38.4 per 100 prescriptions (95% CI, 27.4-53.9) at one year (p = 0.54). At one year, the error rate for e-prescribing adopters was significantly lower than for non-adopters (p < 0.001). Illegibility errors were very high at baseline and were completely eliminated by e-prescribing (87.6 per 100 prescriptions at baseline for e-prescribing adopters, 0 at one year).
Prescribing errors may occur much more frequently in community-based practices than previously reported. Our preliminary findings suggest that stand-alone e-prescribing with clinical decision support may significantly improve ambulatory medication safety.
ClinicalTrials.gov, Taconic Health Information Network and Community (THINC), NCT00225563, http://clinicaltrials.gov/ct2/show/NCT00225563?term=Kaushal&rank=6 .
尽管电子处方有望在门诊环境中预防处方错误，但关于其有效性的研究尚无定论。
评估独立电子处方系统对门诊处方错误发生率及类型的影响。
设计、参与者：前瞻性、非随机研究，采用前后对照设计，对2005年9月至2007年6月期间采用电子处方的15名医疗服务提供者进行研究，并同时对照15名使用纸质处方的医疗服务提供者。
使用具有临床决策支持功能的商业独立电子处方系统，包括剂量推荐以及对药物过敏相互作用、药物相互作用和重复治疗的检查。
通过标准化处方和病历审查来识别处方错误。
我们在基线时分析了3684份纸质处方，在随访一年时分析了3848份纸质处方和电子处方。对于采用电子处方的人，错误率下降了近7倍，从基线时每100张处方42.5例（95%置信区间[CI]，36.7 - 49.3）降至采用后一年时每100张处方6.6例（95%CI，5.1 - 8.3）（p < 0.001）。对于未采用者，基线时错误率仍然很高，为每100张处方37.3例（95%CI，27.6 - 50.2），一年时为每100张处方38.4例（95%CI，27.4 - 53.9）（p = 0.54）。一年时，采用电子处方者的错误率显著低于未采用者（p < 0.001）。字迹模糊错误在基线时非常高，而电子处方完全消除了此类错误（采用电子处方者基线时每100张处方87.6例，一年时为0例）。
社区医疗实践中的处方错误发生率可能比之前报道的要高得多。我们的初步研究结果表明，具有临床决策支持功能的独立电子处方可能会显著提高门诊用药安全性。
ClinicalTrials.gov，塔科尼克健康信息网络与社区（THINC），NCT00225563，http://clinicaltrials.gov/ct2/show/NCT00225563?term=Kaushal&rank=6 。
