University of Wisconsin-Madison, Madison, WI 53706, United States.
Int J Med Inform. 2012 Nov;81(11):782-91. doi: 10.1016/j.ijmedinf.2012.07.011. Epub 2012 Sep 2.
To examine the effect of implementing electronic order management on the timely administration of antibiotics to critical-care patients.
We used a prospective pre-post design, collecting data on first-dose IV antibiotic orders before and after the implementation of an integrated electronic medication-management system, which included computerized provider order entry (CPOE), pharmacy order processing and an electronic medication administration record (eMAR). The research was performed in a 24-bed adult medical/surgical ICU in a large, rural, tertiary medical center. Data on the time of ordering, pharmacy processing and administration were prospectively collected and time intervals for each stage and the overall process were calculated.
The overall turnaround time from ordering to administration significantly decreased from a median of 100 min before order management implementation to a median of 64 min after implementation. The first part of the medication use process, i.e., from order entry to pharmacy processing, improved significantly whereas no change was observed in the phase from pharmacy processing to medication administration.
The implementation of an electronic order-management system improved the timeliness of antibiotic administration to critical-care patients. Additional system changes are required to further decrease the turnaround time.
考察实施电子医嘱管理对重症监护患者抗生素及时给药的影响。
我们采用前瞻性前后对照设计，在实施集成电子药物管理系统前后收集首剂静脉用抗生素医嘱的数据，该系统包括计算机医嘱录入（CPOE）、药房处理和电子医嘱记录（eMAR）。研究在一家大型农村三级医疗中心的 24 张成人内科/外科 ICU 中进行。前瞻性收集关于医嘱下达、药房处理和给药的时间数据，并计算每个阶段和整个过程的时间间隔。
从医嘱下达至给药的整体周转时间从实施医嘱管理前的中位数 100 分钟显著缩短至实施后的中位数 64 分钟。药物使用过程的第一部分，即从医嘱录入到药房处理，显著改善，而从药房处理到给药阶段则没有变化。
实施电子医嘱管理系统提高了重症监护患者抗生素给药的及时性。需要进一步的系统改变来进一步缩短周转时间。
