使用硬软停止警报的计算机剂量范围检查可减少儿科重症监护病房的处方错误。

Computerized Dose Range Checking Using Hard and Soft Stop Alerts Reduces Prescribing Errors in a Pediatric Intensive Care Unit.

机构信息

From *The University of Arizona College of Medicine-Phoenix; and †Department of Pediatric Critical Care, Phoenix Children's Hospital, Phoenix, Arizona.

出版信息

J Patient Saf. 2017 Sep;13(3):144-148. doi: 10.1097/PTS.0000000000000132.

DOI:10.1097/PTS.0000000000000132

PMID:25370855

Abstract

OBJECTIVE

An enhanced dose range checking (DRC) system was developed to evaluate prescription error rates in the pediatric intensive care unit and the pediatric cardiovascular intensive care unit.

METHODS

An enhanced DRC system incorporating "soft" and "hard" alerts was designed and implemented. Practitioner responses to alerts for patients admitted to the pediatric intensive care unit and the pediatric cardiovascular intensive care unit were retrospectively reviewed.

RESULTS

Alert rates increased from 0.3% to 3.4% after "go-live" (P < 0.001). Before go-live, all alerts were soft alerts. In the period after go-live, 68% of alerts were soft alerts and 32% were hard alerts. Before go-live, providers reduced doses only 1 time for every 10 dose alerts. After implementation of the enhanced computerized physician order entry system, the practitioners responded to soft alerts by reducing doses to more appropriate levels in 24.7% of orders (70/283), compared with 10% (3/30) before go-live (P = 0.0701). The practitioners deleted orders in 9.5% of cases (27/283) after implementation of the enhanced DRC system, as compared with no cancelled orders before go-live (P = 0.0774). Medication orders that triggered a soft alert were submitted unmodified in 65.7% (186/283) as compared with 90% (27/30) of orders before go-live (P = 0.0067). After go-live, 28.7% of hard alerts resulted in a reduced dose, 64% resulted in a cancelled order, and 7.4% were submitted as written.

CONCLUSIONS

Before go-live, alerts were often clinically irrelevant. After go-live, there was a statistically significant decrease in orders that were submitted unmodified and an increase in the number of orders that were reduced or cancelled.

摘要

目的

开发了增强型剂量范围检查（DRC）系统，以评估儿科重症监护病房和儿科心血管重症监护病房的处方错误率。

方法

设计并实施了一种包含“软”和“硬”警报的增强型 DRC 系统。回顾性审查了对儿科重症监护病房和儿科心血管重症监护病房患者的警报的医生反应。

结果

“上线”后，警报率从 0.3%增加到 3.4%（P<0.001）。上线前，所有警报均为软警报。在上线后期间，68%的警报为软警报，32%为硬警报。上线前，提供者每 10 次剂量警报仅减少一次剂量。在增强型计算机化医嘱输入系统实施后，医生对软警报的反应是将剂量降低到更合适的水平，在 283 个订单中的 24.7%（70/283），而在上线前为 10%（3/30）（P=0.0701）。在增强型 DRC 系统实施后，医生在 9.5%的情况下（27/283）删除了订单，而在上线前没有取消订单（P=0.0774）。触发软警报的药物医嘱以未修改的形式提交，占 65.7%（186/283），而上线前为 90%（27/30）（P=0.0067）。上线后，28.7%的硬警报导致剂量降低，64%导致订单取消，7.4%按原样提交。