Division of Nephrology, University of Virginia Health System, Box 80013, 1215 Lee Street, Charlottesville, VA 22908, USA.
Nat Rev Nephrol. 2011 Jun;7(6):348-55. doi: 10.1038/nrneph.2011.50. Epub 2011 Apr 19.
Incorrect prescription and administration of medications account for a substantial proportion of medical errors in the USA, causing adverse drug events (ADEs) that result in considerable patient morbidity and enormous costs to the health-care system. Patients with chronic kidney disease or acute kidney injury often have impaired drug clearance as well as polypharmacy, and are therefore at increased risk of experiencing ADEs. Studies have demonstrated that recognition of these conditions is not uniform among treating physicians, and prescribed drug doses are often incorrect. Early interventions that ensure appropriate drug dosing in this group of patients have shown encouraging results. Both computerized physician order entry and clinical decision support systems have been shown to reduce the rate of ADEs. Nevertheless, these systems have been implemented at surprisingly few institutions. Economic stimulus and health-care reform legislation present a rare opportunity to refine these systems and understand how they could be implemented more widely. Failure to explore this technology could mean that the opportunity to reduce the morbidity associated with ADEs is missed.
在美国，药物的不正确处方和给药是医疗差错的一个重要原因，导致不良药物事件（ADE），从而给患者带来相当大的发病率，并给医疗保健系统带来巨大的成本。患有慢性肾病或急性肾损伤的患者常常存在药物清除能力受损以及多种药物同时使用的情况，因此发生 ADE 的风险增加。研究表明，治疗医生对这些情况的认识并不一致，而且开出的药物剂量往往不正确。在这组患者中进行早期干预以确保适当的药物剂量已显示出令人鼓舞的结果。已经证明，计算机化医生医嘱输入和临床决策支持系统都可以降低 ADE 的发生率。然而，这些系统在为数不多的机构中得到了实施。经济刺激和医疗改革立法提供了一个难得的机会，可以完善这些系统，并了解如何更广泛地实施这些系统。如果不探索这项技术，就有可能错失减少与 ADE 相关发病率的机会。
