Abramson Erika L, Barrón Yolanda, Quaresimo Jill, Kaushal Rainu
Weill Medical College of Cornell University, New York, USA.
Jt Comm J Qual Patient Saf. 2011 Oct;37(10):470-8. doi: 10.1016/s1553-7250(11)37060-2.
Health policy forces are promoting the adoption of interoperable electronic health records (EHRs) with electronic prescribing (e-prescribing). Despite the promise of EHRs with e-prescribing to improve medication safety in ambulatory care settings--where most prescribing occurs and where errors are common--few studies have demonstrated its effectiveness. A study was conducted to assess the effect of an e-prescribing system with clinical decision support, including checks for drug allergies and drug-drug interactions, that was integrated within an EHR on rates of ambulatory prescribing errors.
In a prospective study using a nonrandomized, pre-post design with concurrent controls, 6 providers who used a commercial e-prescribing system were compared with 15 providers who remained paper-based from September 2005 through July 2008. Prescribing errors were identified by a standardized prescription and chart review.
Some 2,432 paper prescriptions at baseline and 2,079 prescriptions at one year were analyzed. Error rates for e-prescribing adopters decreased 1.5-fold--from 26.0 errors per 100 prescriptions at baseline (95% confidence interval [CI], 17.4-38.9) to 16.0 errors per 100 prescriptions at one year (95% CI, 12.7-20.2; p = .09). Error rates remained unchanged for nonadopters (37.3 per 100 prescriptions at baseline, 95% CI, 27.6-50.2, versus 38.4 per 100 prescriptions at one year, 95% CI 27.4-53.9; p = .54). Error rates for e-prescribing adopters were significantly lower than for nonadopters at one year (p < .001). Illegibility errors were high at baseline and eliminated by e-prescribing.
The preliminary findings from this small group of providers suggest that e-prescribing systems may decrease ambulatory prescribing errors, which are occurring at high rates among community-based providers.
卫生政策力量正在推动采用具有电子处方功能的可互操作电子健康记录（EHR）。尽管具有电子处方功能的EHR有望改善门诊护理环境中的用药安全——大多数处方开具于此且错误常见——但很少有研究证明其有效性。开展了一项研究，以评估整合于EHR中的具有临床决策支持功能（包括药物过敏和药物相互作用检查）的电子处方系统对门诊处方错误率的影响。
在一项前瞻性研究中，采用非随机、前后对照设计并设置同期对照，将6名使用商业电子处方系统的医疗服务提供者与2005年9月至2008年7月期间仍采用纸质处方的15名医疗服务提供者进行比较。通过标准化处方和病历审查来识别处方错误。
共分析了基线时约2432份纸质处方和一年时的2079份处方。采用电子处方者的错误率降低了1.5倍——从基线时每100份处方26.0个错误（95%置信区间[CI]，17.4 - 38.9）降至一年时每100份处方16.0个错误（95%CI，12.7 - 20.2；p = 0.09）。未采用电子处方者（基线时每100份处方37.3个错误，95%CI，27.6 - 50.2，一年时每100份处方38.4个错误，95%CI 27.4 - 53.9；p = 0.54）的错误率保持不变。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）。基线时字迹模糊错误率较高，电子处方消除了此类错误。
这一小群医疗服务提供者的初步研究结果表明，电子处方系统可能会降低门诊处方错误率，而社区医疗服务提供者中的此类错误发生率较高。
