Surgery, University of Wisconsin School of Medicine and Public Health.
Formerly at Geisinger Health System, Danville, Pennsylvania.
J Patient Saf. 2021 Aug 1;17(5):e429-e439. doi: 10.1097/PTS.0000000000000358.
The aim of the study was to assess the impact of Electronic Health Record (EHR) implementation on medication safety in two intensive care units (ICUs).
Using a prospective pre-post design, we assessed 1254 consecutive admissions to two ICUs before and after an EHR implementation. Each medication event was evaluated with regard to medication error (error type, medication-management stage) and impact on patient (severity of potential or actual harm).
We identified 4063 medication-related events either pre-implementation (2074 events) or post-implementation (1989 events). Although the overall potential for harm due to medication errors decreased post-implementation only 2 of the 3 error rates were significantly lower post-implementation. After EHR implementation, we observed reductions in rates of medication errors per admission at the stages of transcription (0.13-0, P < 0.001), dispensing (0.49-0.16, P < 0.001), and administration (0.83-0.56, P = 0.011). Within the ordering stage, 4 error types decreased post-implementation (orders with omitted information, error-prone abbreviations, illegible orders, failure to renew orders) and 4 error types increased post-implementation (orders of wrong drug, orders containing a wrong start or stop time, duplicate orders, orders with inappropriate or wrong information). Within the administration stage, we observed a reduction of late administrations and increases in omitted administrations and incorrect documentation.
Electronic Health Record implementation in two ICUs was associated with both improvement and worsening in rates of specific error types. Further safety improvements require a nuanced understanding of how various error types are influenced by the technology and the sociotechnical work system of the technology implementation. Recommendations based on human factors engineering principles are provided for reducing medication errors.
本研究旨在评估电子病历（EHR）在两个重症监护病房（ICU）实施对用药安全的影响。
采用前瞻性前后设计，我们评估了两个 ICU 中 1254 例连续入院患者在 EHR 实施前后的情况。评估了每个用药事件的用药错误（错误类型、用药管理阶段）和对患者的影响（潜在或实际伤害的严重程度）。
我们发现 4063 例与用药相关的事件，分别在实施前（2074 例）和实施后（1989 例）。尽管由于用药错误而导致的潜在危害总体下降，但只有 3 种错误率中的 2 种在实施后显著降低。在实施 EHR 后，我们观察到每例入院时转录（0.13-0，P < 0.001）、配药（0.49-0.16，P < 0.001）和给药（0.83-0.56，P = 0.011）阶段的用药错误率降低。在医嘱阶段，有 4 种错误类型在实施后减少（医嘱信息遗漏、易出错的缩写、医嘱难以辨认、医嘱未续开），有 4 种错误类型增加（医嘱开错药物、医嘱起始或停止时间错误、重复医嘱、医嘱信息不当或错误）。在给药阶段，我们观察到迟给药减少，漏给药和不正确记录增加。
在两个 ICU 中实施电子病历与特定错误类型的发生率提高和降低均有关。要进一步提高安全性，需要深入了解各种错误类型如何受到技术以及技术实施的社会技术工作系统的影响。根据人为因素工程原则提出了减少用药错误的建议。
