Indiana University Center for Aging Research, Indianapolis, IN, USA.
Ann Emerg Med. 2010 Dec;56(6):623-9. doi: 10.1016/j.annemergmed.2010.03.025. Epub 2010 May 10.
Emergency physicians prescribe several discharge medications that require dosage adjustment for patients with renal disease. The hypothesis for this research was that decision support in a computerized physician order entry system would reduce the rate of excessive medication dosing for patients with renal impairment.
This was a randomized, controlled trial in an academic emergency department (ED), in which computerized physician order entry was used to write all prescriptions for patients being discharged from the ED. The sample included 42 physicians who were randomized to the intervention (21 physicians) or control (21 physicians) group. The intervention was decision support that provided dosing recommendations for targeted medications for patients aged 18 years and older when the patient's estimated creatinine clearance level was below the threshold for dosage adjustment. The primary outcome was the proportion of targeted medications that were excessively dosed.
For 2,783 (46%) of the 6,015 patient visits, the decision support had sufficient information to estimate the patient's creatinine clearance level. The average age of these patients was 46 years, 1,768 (64%) were women, and 1,523 (55%) were black. Decision support was provided 73 times to physicians in the intervention group, who excessively dosed 31 (43%) prescriptions. In comparison, control physicians excessively dosed a significantly larger proportion of medications: 34 of 46, 74% (effect size=31%; 95% confidence interval 14% to 49%; P=.001).
Emergency physicians often prescribed excessive doses of medications that require dosage adjustment for renal impairment. Computerized physician order entry with decision support significantly reduced excessive dosing of targeted medications.
急诊医师为患有肾脏疾病的患者开出了几种需要根据肾功能调整剂量的出院药物。本研究的假设是，在计算机化的医嘱录入系统中提供决策支持，将降低肾功能受损患者药物剂量过大的发生率。
这是一项在学术急诊部（ED）进行的随机对照试验，在该试验中，计算机化的医嘱录入系统用于为从 ED 出院的所有患者开具处方。该样本包括 42 名随机分配到干预（21 名医生）或对照组（21 名医生）的医生。干预措施是针对年龄在 18 岁及以上的患者的目标药物的剂量建议，当患者的估计肌酐清除率低于剂量调整阈值时，为患者提供决策支持。主要结果是目标药物中剂量过大的比例。
对于 6015 次患者就诊中的 2783 次（46%），决策支持有足够的信息来估计患者的肌酐清除率。这些患者的平均年龄为 46 岁，1768 名（64%）为女性，1523 名（55%）为黑人。干预组的医生共收到决策支持 73 次，其中 31 次（43%）处方药物剂量过大。相比之下，对照组的医生开的药物剂量过大的比例明显更大：46 次中有 34 次，74%（效应量=31%；95%置信区间 14%至 49%；P=0.001）。
急诊医师经常开出需要根据肾功能调整剂量的药物的过大剂量。具有决策支持的计算机化医嘱录入显著减少了目标药物剂量过大的情况。
