Kannampallil Thomas G, Abraham Joanna, Solotskaya Anna, Philip Sneha G, Lambert Bruce L, Schiff Gordon D, Wright Adam, Galanter William L
Department of Family Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, Northwestern University, Chicago, IL, USA.
J Am Med Inform Assoc. 2017 Jul 1;24(4):762-768. doi: 10.1093/jamia/ocw187.
Medication order voiding allows clinicians to indicate that an existing order was placed in error. We explored whether the order voiding function could be used to record and study medication ordering errors.
We examined medication orders from an academic medical center for a 6-year period (2006-2011; n = 5 804 150). We categorized orders based on status (void, not void) and clinician-provided reasons for voiding. We used multivariable logistic regression to investigate the association between order voiding and clinician, patient, and order characteristics. We conducted chart reviews on a random sample of voided orders ( n = 198) to investigate the rate of medication ordering errors among voided orders, and the accuracy of clinician-provided reasons for voiding.
We found that 0.49% of all orders were voided. Order voiding was associated with clinician type (physician, pharmacist, nurse, student, other) and order type (inpatient, prescription, home medications by history). An estimated 70 ± 10% of voided orders were due to medication ordering errors. Clinician-provided reasons for voiding were reasonably predictive of the actual cause of error for duplicate orders (72%), but not for other reasons.
Medication safety initiatives require availability of error data to create repositories for learning and training. The voiding function is available in several electronic health record systems, so order voiding could provide a low-effort mechanism for self-reporting of medication ordering errors. Additional clinician training could help increase the quality of such reporting.
医嘱作废功能使临床医生能够表明现有医嘱是错误开具的。我们探讨了该医嘱作废功能是否可用于记录和研究用药医嘱错误。
我们检查了一家学术医疗中心6年期间（2006 - 2011年；n = 5804150）的用药医嘱。我们根据状态（作废、未作废）以及临床医生提供的作废原因对医嘱进行分类。我们使用多变量逻辑回归来研究医嘱作废与临床医生、患者及医嘱特征之间的关联。我们对随机抽取的作废医嘱样本（n = 198）进行病历审查，以调查作废医嘱中用药医嘱错误的发生率，以及临床医生提供的作废原因的准确性。
我们发现所有医嘱中有0.49%被作废。医嘱作废与临床医生类型（医生、药剂师、护士、学生、其他）和医嘱类型（住院患者、处方、既往家庭用药）相关。估计70±10%的作废医嘱是由于用药医嘱错误。临床医生提供的作废原因对于重复医嘱错误的实际原因具有合理的预测性（72%），但对于其他原因则不然。
用药安全举措需要有错误数据来创建学习和培训的知识库。作废功能在多个电子健康记录系统中都有，因此医嘱作废可为用药医嘱错误的自我报告提供一种省力的机制。额外的临床医生培训有助于提高此类报告的质量。
