Department of Hospital Pharmacy, Hospital Röpcke-Zweers, Hardenberg, The Netherlands.
Int J Clin Pharm. 2013 Apr;35(2):195-201. doi: 10.1007/s11096-012-9727-y. Epub 2012 Nov 28.
Computerized physician order entry (CPOE) in hospitals is widely considered to be important for patient safety, but implementation is lagging behind and user satisfaction is often low. Risk analysis methods may improve the implementation process and thus user satisfaction. Objective The aim of our study was to determine the association of performing risk analysis with user satisfaction after implementation of CPOE. Setting All hospitals in the Netherlands.
A cross-sectional study using a questionnaire was performed. All Dutch hospital pharmacies were asked about the extent of implementation of CPOE in the hospitals they served, the performance of (retrospective or prospective) risk analysis and the satisfaction with CPOE of doctors, nurses and pharmacists. Only hospitals that had implemented inpatient CPOE on at least 70 % of the wards were included in the primary analysis.
The primary outcome measure was the proportion of hospital pharmacists with a satisfaction level of 4 or 5 (i.e. 'satisfied'). The secondary outcome measure was the proportion of medical doctors and nurses with a satisfaction level of 4 or 5 (i.e. satisfied). The main determinant was the performance of a formal method of prospective or retrospective risk analysis.
The questionnaire was sent to all 79 Dutch hospital pharmacies. Questionnaires were returned by 70 hospital pharmacies, serving 72 separate hospitals. In 40 hospitals the CPOE was implemented on at least 70 % of the wards. The association of risk analysis with the proportion of satisfied users was determined within this group of 40 hospitals. For hospital pharmacists we found that the performance of risk analysis showed a statistically non-significant trend towards an association with satisfaction [OR 3.3 (95 % CI 0.8-14.1)]. For medical doctors the performance of risk analysis was associated with satisfaction [OR 10.0 (95 % CI 1.8-56.0)]. Also a statistically non-significant trend towards an association with satisfaction was found for nurses [OR 4.5 (95 % CI 0.8-24.7)].
Although not statistically significant, the user satisfaction with CPOE seems to be associated with the performance of risk analysis during the implementation of CPOE. This suggests that the CPOE implementation process can be optimized by performing risk analysis before and/or after implementation.
计算机化医嘱录入（CPOE）在医院中被广泛认为对患者安全至关重要，但实施情况滞后，用户满意度通常较低。风险分析方法可以改善实施过程，从而提高用户满意度。目的：本研究旨在确定实施 CPOE 后进行风险分析与用户满意度之间的关系。地点：荷兰所有医院。
采用问卷调查进行横断面研究。所有荷兰医院药剂师被问及他们服务的医院中 CPOE 的实施程度、（回顾性或前瞻性）风险分析的执行情况以及医生、护士和药剂师对 CPOE 的满意度。仅纳入已在至少 70%的病房实施住院 CPOE 的医院进行主要分析。
主要结局指标是对 CPOE 满意度为 4 或 5（即“满意”）的医院药剂师的比例。次要结局指标是对 CPOE 满意度为 4 或 5（即“满意”）的医生和护士的比例。主要决定因素是执行正式的前瞻性或回顾性风险分析方法。
问卷发送给了所有 79 家荷兰医院药剂师。70 家医院药剂师回复了问卷，共涉及 72 家不同的医院。在 40 家医院中，CPOE 已在至少 70%的病房实施。在这 40 家医院中，确定了风险分析与满意用户比例之间的关系。对于医院药剂师，我们发现风险分析的执行情况与满意度呈统计学上无显著关联趋势[比值比 3.3（95%置信区间 0.8-14.1）]。对于医生，风险分析的执行情况与满意度相关[比值比 10.0（95%置信区间 1.8-56.0）]。对于护士，也发现与满意度呈统计学上无显著关联趋势[比值比 4.5（95%置信区间 0.8-24.7）]。
虽然没有统计学意义，但 CPOE 的用户满意度似乎与 CPOE 实施过程中的风险分析执行情况相关。这表明，通过在实施前后执行风险分析，可以优化 CPOE 的实施过程。
