Duke University Hospital, Durham, North Carolina 27710, USA.
J Patient Saf. 2013 Jun;9(2):103-9. doi: 10.1097/PTS.0b013e318281b866.
Medication errors account for 20% of medical errors in the United States with the largest risk at prescribing and administration. Analgesics or opioids are frequently used medications that can be associated with patient harm when prescribed or administered improperly. In an effort to decrease medication errors, Duke University Hospital implemented clinical decision support via computer provider order entry (CPOE) and "smart pump" technology, 2/2008, with the goal to decrease patient-controlled analgesia (PCA) adverse events.
This project evaluated PCA safety events, reviewing voluntary report system and adverse drug events via surveillance (ADE-S), on intermediate and step-down units preimplementation and postimplementation of clinical decision support via CPOE and PCA smart pumps for the prescribing and administration of opioids therapy in the adult patient requiring analgesia for acute pain.
Voluntary report system and ADE-S PCA events decreased based upon 1000 PCA days; ADE-S PCA events per 1000 PCA days decreased 22%, from 5.3 (pre) to 4.2 (post) (P = 0.09). Voluntary report system events decreased 72%, from 2.4/1000 PCA days (pre) to 0.66/1000 PCA days (post) and was statistically significant (P < 0.001). There was a difference in the ADE-S data for causality (P < 0.0001) with sleep apnea and renal insufficiency approaching significance. Voluntary report system safety event were statistically significant for obesity [body mass index (BMI) ≥30] and weight.
This study demonstrated a decrease in PCA events between time periods in both the ADE-S and voluntary report system data, thus supporting the recommendation of clinical decision support via CPOE and PCA smart pump technology.
在美国，药物错误占医疗差错的 20%，而在处方和给药方面风险最大。在处方或给药不当的情况下，经常使用的镇痛药或阿片类药物可能会对患者造成伤害。为了减少药物错误，杜克大学医院于 2008 年 2 月通过计算机医嘱输入（CPOE）和“智能输液泵”技术实施了临床决策支持，目标是减少患者自控镇痛（PCA）不良事件。
本项目评估了 PCA 安全事件，在实施 CPOE 和 PCA 智能输液泵前后，通过自愿报告系统和药物不良事件监测（ADE-S）回顾了中级和降阶梯病房的阿片类药物治疗成人急性疼痛患者的处方和给药情况。
基于 1000 例 PCA 天数，自愿报告系统和 ADE-S PCA 事件减少；ADE-S PCA 事件每 1000 例 PCA 天数减少 22%，从 5.3（之前）降至 4.2（之后）（P=0.09）。自愿报告系统事件减少 72%，从每 1000 例 PCA 天数 2.4 例（之前）降至 0.66 例（之后），且具有统计学意义（P<0.001）。ADE-S 数据的因果关系（P<0.0001）存在差异，其中睡眠呼吸暂停和肾功能不全接近显著。自愿报告系统安全事件在肥胖（BMI≥30）和体重方面具有统计学意义。
本研究表明，在 ADE-S 和自愿报告系统数据中，PCA 事件在两个时间段之间均有所减少，因此支持通过 CPOE 和 PCA 智能输液泵技术实施临床决策支持的建议。
