电子处方（eP）中的用药错误：同一画面的两种视角。
Medication errors with electronic prescribing (eP): Two views of the same picture.
机构信息
Department of Practice and Policy, the School of Pharmacy University of London, London, UK.
出版信息
BMC Health Serv Res. 2010 May 24;10:135. doi: 10.1186/1472-6963-10-135.
BACKGROUND
Quantitative prospective methods are widely used to evaluate the impact of new technologies such as electronic prescribing (eP) on medication errors. However, they are labour-intensive and it is not always feasible to obtain pre-intervention data. Our objective was to compare the eP medication error picture obtained with retrospective quantitative and qualitative methods.
METHODS
The study was carried out at one English district general hospital approximately two years after implementation of an integrated electronic prescribing, administration and records system. QUANTITATIVE: A structured retrospective analysis was carried out of clinical records and medication orders for 75 randomly selected patients admitted to three wards (medicine, surgery and paediatrics) six months after eP implementation. QUALITATIVE: Eight doctors, 6 nurses, 8 pharmacy staff and 4 other staff at senior, middle and junior grades, and 19 adult patients on acute surgical and medical wards were interviewed. Staff interviews explored experiences of developing and working with the system; patient interviews focused on experiences of medicine prescribing and administration on the ward. Interview transcripts were searched systematically for accounts of medication incidents. A classification scheme was developed and applied to the errors identified in the records review.
RESULTS
The two approaches produced similar pictures of the drug use process. Interviews identified types of error identified in the retrospective notes review plus two eP-specific errors which were not detected by record review. Interview data took less time to collect than record review, and provided rich data on the prescribing process, and reasons for delays or non-administration of medicines, including "once only" orders and "as required" medicines.
CONCLUSIONS
The qualitative approach provided more understanding of processes, and some insights into why medication errors can happen. The method is cost-effective and could be used to supplement information from anonymous error reporting schemes.
背景
定量前瞻性方法被广泛用于评估电子处方（eP）等新技术对用药错误的影响。然而，这些方法需要大量的人力，并且并不总是能够获得干预前的数据。我们的目的是比较使用回顾性定量和定性方法获得的 eP 用药错误情况。
方法
该研究在一家英国地区综合医院进行，在实施集成电子处方、医嘱和记录系统大约两年后。定量：对 75 名随机选择的患者的临床记录和医嘱进行了结构化的回顾性分析，这些患者在 eP 实施后六个月入住了三个病房（内科、外科和儿科）。定性：采访了 8 名医生、6 名护士、8 名药剂师和 4 名不同级别（高级、中级和初级）的其他工作人员，以及 19 名在急症外科和内科病房的成年患者。工作人员访谈探讨了开发和使用该系统的经验；患者访谈侧重于病房内的配药和用药经历。对访谈记录进行了系统搜索，以查找用药事件的报告。制定并应用了一种分类方案，对记录审查中发现的错误进行分类。
结果
这两种方法得出了相似的用药过程图片。访谈中发现了回顾性笔记审查中确定的错误类型，以及电子处方特定的两种错误，这些错误在记录审查中没有被发现。与记录审查相比，访谈数据的收集时间更短，并且提供了丰富的配药过程数据，以及用药延迟或未用药的原因，包括“一次用量”医嘱和“按需”药物。
结论
定性方法提供了对流程的更多理解，以及对用药错误发生原因的一些见解。该方法具有成本效益，可用于补充匿名错误报告方案的信息。
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