重症监护病房中与药物相关的临床决策支持警报覆盖的评估。
Evaluation of medication-related clinical decision support alert overrides in the intensive care unit.
作者信息
Wong Adrian, Amato Mary G, Seger Diane L, Slight Sarah P, Beeler Patrick E, Dykes Patricia C, Fiskio Julie M, Silvers Elizabeth R, Orav E John, Eguale Tewodros, Bates David W
机构信息
The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; MCPHS University, Boston, MA, USA.
The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Partners HealthCare, Wellesley, Boston, MA, USA.
出版信息
J Crit Care. 2017 Jun;39:156-161. doi: 10.1016/j.jcrc.2017.02.027. Epub 2017 Feb 20.
PURPOSE
Medication-related clinical decision support (CDS) has been identified as a method to improve patient outcomes but is historically frequently overridden and may be inappropriately so. Patients in the intensive care unit (ICU) are at a higher risk of harm from adverse drug events (ADEs) and these overrides may increase patient harm. The objective of this study is to determine appropriateness of overridden medication-related CDS overrides in the ICU.
MATERIALS AND METHODS
We evaluated overridden medication-related alerts of four alert categories from January 2009 to December 2011. The primary outcome was the appropriateness of a random sample of overrides based on predetermined criteria. Secondary outcomes included the incidence of adverse drug events (ADEs) that resulted from the overridden alert.
RESULTS
A total of 47,449 overridden alerts were included for evaluation. The appropriateness rate for overridden alerts varied by alert category (allergy: 94%, drug-drug interaction: 84%, geriatric: 57%, renal: 27%). A total of seven actual ADEs were identified in the random sample and where the medication(s) was administered (n=366), with an increased risk of ADEs associated with inappropriately overridden alerts (p=0.0078).
CONCLUSIONS
The appropriateness of medication-related clinical decision support overrides in the ICU varied substantially by the type of alert. Inappropriately overridden alerts were associated with an increased risk of ADEs compared to appropriately overridden alerts.
目的
药物相关临床决策支持（CDS）已被视为改善患者治疗效果的一种方法，但历来经常被忽视，而且这种忽视可能并不恰当。重症监护病房（ICU）的患者因药物不良事件（ADEs）而受到伤害的风险更高，而这些忽视可能会增加患者受到的伤害。本研究的目的是确定ICU中被忽视的药物相关CDS的适当性。
材料与方法
我们评估了2009年1月至2011年12月期间四类警报中被忽视的药物相关警报。主要结果是根据预定标准对随机抽取的忽视样本的适当性进行评估。次要结果包括由被忽视警报导致的药物不良事件（ADEs）的发生率。
结果
总共纳入47449条被忽视的警报进行评估。被忽视警报的适当率因警报类别而异（过敏：94%，药物相互作用：84%，老年：57%，肾脏：27%）。在随机样本以及用药的情况（n = 366）中总共识别出7起实际的ADEs，与不适当被忽视的警报相关的ADEs风险增加（p = 0.0078）。
结论
ICU中药物相关临床决策支持被忽视的适当性因警报类型而异。与适当被忽视的警报相比，不适当被忽视的警报与ADEs风险增加相关。
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