From the School of Medicine, University of Adelaide South Australia, 5000, Pharmacy Department, Level 2 East Wing, Royal Adelaide Hospital, 50 North Tce, Adelaide, South Australia 5000, Australia, Flinders Centre for Epidemiology and Biostatistics, Flinders University, Bedford Park, South Australia 5042 and School of Medicine, University of Adelaide, South Australia 5000, Australia.
QJM. 2015 May;108(5):369-77. doi: 10.1093/qjmed/hcu213. Epub 2014 Oct 15.
Prescribing is a complex task with potential for many types of error to occur. Despite the introduction of a standard national medication chart for Australian hospital inpatients in 2006, simple prescribing errors are common.
To compare the effect of quality improvement initiatives on the rate of simple prescribing errors.
A prospective, multisite comparison of prescribing education interventions.
Using three hospital sites, we compared site-specific changes in prescribing error rates following use of an online education module alone (low intensity) with prescribing error rates following a high-intensity intervention (comprising the same online education module plus nurse education and academic detailing of junior prescribers). The study period was 4 months between May and August 2011.
Full completion of the adverse drug reactions field did not improve after either intervention; however, there was better documentation of some elements following high-intensity intervention. Prescriber performance improved significantly for more elements in the regular prescription category than any other category of prescription. Legibility of medication name improved across all categories following interventions. Clarity of frequency, prescriber name and documentation of indication improved following both high- and low-intensity intervention.
Improvements were seen in several prescription elements after the intervention but the majority of elements that improved were affected by both low- and high-intensity interventions. Despite targeted intervention, significant rates of prescribing breaches persisted. The prevalence of prescription breaches partially responds to an online education module. The nature of any additional intervention that would be effective is unclear.
开处方是一项复杂的任务，可能会出现多种类型的错误。尽管 2006 年澳大利亚医院为住院患者引入了标准的国家用药图表，但简单的处方错误仍然很常见。
比较质量改进措施对简单处方错误率的影响。
一项针对处方教育干预措施的前瞻性、多地点比较。
我们使用三个医院地点，比较了单独使用在线教育模块（低强度）后（高强度干预措施（包括相同的在线教育模块加上护士教育和初级处方者的学术详述））处方错误率的变化。研究期间为 2011 年 5 月至 8 月的 4 个月。
在任何干预措施后，不良反应字段的完整填写都没有改善；然而，在高强度干预后，一些元素的记录更好。与其他处方类别相比，常规处方类别的更多元素的开处方者表现显著改善。干预措施后，所有类别中的药物名称清晰度都有所提高。在高、低强度干预后，频率、开处方者姓名和适应症记录的清晰度都有所提高。
干预后，几个处方元素得到了改善，但大多数得到改善的元素都受到低强度和高强度干预的影响。尽管进行了有针对性的干预，但仍存在大量的处方违规行为。处方违规的流行部分是对在线教育模块的回应。任何有效的额外干预措施的性质尚不清楚。
