Division of General Medicine Primary Care, Brigham and Women's Hospital, 3/F, 1620 Tremont St., Boston, MA 02120, USA.
N Engl J Med. 2010 May 6;362(18):1698-707. doi: 10.1056/NEJMsa0907115.
Serious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such errors, technology has been developed to verify medications by incorporating bar-code verification technology within an electronic medication-administration system (bar-code eMAR).
We conducted a before-and-after, quasi-experimental study in an academic medical center that was implementing the bar-code eMAR. We assessed rates of errors in order transcription and medication administration on units before and after implementation of the bar-code eMAR. Errors that involved early or late administration of medications were classified as timing errors and all others as nontiming errors. Two clinicians reviewed the errors to determine their potential to harm patients and classified those that could be harmful as potential adverse drug events.
We observed 14,041 medication administrations and reviewed 3082 order transcriptions. Observers noted 776 nontiming errors in medication administration on units that did not use the bar-code eMAR (an 11.5% error rate) versus 495 such errors on units that did use it (a 6.8% error rate)--a 41.4% relative reduction in errors (P<0.001). The rate of potential adverse drug events (other than those associated with timing errors) fell from 3.1% without the use of the bar-code eMAR to 1.6% with its use, representing a 50.8% relative reduction (P<0.001). The rate of timing errors in medication administration fell by 27.3% (P<0.001), but the rate of potential adverse drug events associated with timing errors did not change significantly. Transcription errors occurred at a rate of 6.1% on units that did not use the bar-code eMAR but were completely eliminated on units that did use it.
Use of the bar-code eMAR substantially reduced the rate of errors in order transcription and in medication administration as well as potential adverse drug events, although it did not eliminate such errors. Our data show that the bar-code eMAR is an important intervention to improve medication safety. (ClinicalTrials.gov number, NCT00243373.)
严重的用药错误在医院中很常见，通常发生在医嘱转录或给药期间。为了帮助预防此类错误，已经开发出技术来验证药物，即在电子用药管理系统（条码 eMAR）中纳入条码验证技术。
我们在一家正在实施条码 eMAR 的学术医疗中心进行了一项前后对照、准实验研究。我们评估了在实施条码 eMAR 前后，使用电子用药管理系统前后的单位中医嘱转录和给药的错误率。涉及药物提前或延迟给药的错误被归类为时间错误，其他错误被归类为非时间错误。两名临床医生审查了错误，以确定其对患者造成伤害的可能性，并将那些可能造成伤害的错误归类为潜在的药物不良事件。
我们观察了 14041 次给药，并审查了 3082 次医嘱转录。观察者注意到在未使用条码 eMAR 的单位中，有 776 次非时间错误的给药（错误率为 11.5%），而在使用条码 eMAR 的单位中，有 495 次此类错误（错误率为 6.8%）-错误率相对降低了 41.4%（P<0.001）。除了与时间错误相关的药物不良事件外，未使用条码 eMAR 的潜在药物不良事件发生率为 3.1%，而使用后的发生率为 1.6%，相对降低了 50.8%（P<0.001）。给药时的时间错误率下降了 27.3%（P<0.001），但与时间错误相关的潜在药物不良事件发生率没有显著变化。在未使用条码 eMAR 的单位中，转录错误的发生率为 6.1%，而在使用条码 eMAR 的单位中，转录错误完全消除。
使用条码 eMAR 大大降低了医嘱转录和给药以及潜在药物不良事件的错误率，尽管它并没有消除这些错误。我们的数据表明，条码 eMAR 是提高用药安全性的重要干预措施。（临床试验注册号，NCT00243373。）
