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内部开发的电子处方对急诊科出院时处方错误的影响。

Impact of Internally Developed Electronic Prescription on Prescribing Errors at Discharge from the Emergency Department.

作者信息

Hitti Eveline, Tamim Hani, Bakhti Rinad, Zebian Dina, Mufarrij Afif

机构信息

American University of Beirut Medical Center, Department of Emergency Medicine, Beirut, Lebanon.

American University of Beirut Medical Center, Department of Internal Medicine and Clinical Research Institute, Beirut, Lebanon.

出版信息

West J Emerg Med. 2017 Aug;18(5):943-950. doi: 10.5811/westjem.2017.6.32037. Epub 2017 Jul 14.

DOI:10.5811/westjem.2017.6.32037
PMID:28874948
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5576632/
Abstract

INTRODUCTION

Medication errors are common, with studies reporting at least one error per patient encounter. At hospital discharge, medication errors vary from 15%-38%. However, studies assessing the effect of an internally developed electronic (E)-prescription system at discharge from an emergency department (ED) are comparatively minimal. Additionally, commercially available electronic solutions are cost-prohibitive in many resource-limited settings. We assessed the impact of introducing an internally developed, low-cost E-prescription system, with a list of commonly prescribed medications, on prescription error rates at discharge from the ED, compared to handwritten prescriptions.

METHODS

We conducted a pre- and post-intervention study comparing error rates in a randomly selected sample of discharge prescriptions (handwritten versus electronic) five months pre and four months post the introduction of the E-prescription. The internally developed, E-prescription system included a list of 166 commonly prescribed medications with the generic name, strength, dose, frequency and duration. We included a total of 2,883 prescriptions in this study: 1,475 in the pre-intervention phase were handwritten (HW) and 1,408 in the post-intervention phase were electronic. We calculated rates of 14 different errors and compared them between the pre- and post-intervention period.

RESULTS

Overall, E-prescriptions included fewer prescription errors as compared to HW-prescriptions. Specifically, E-prescriptions reduced missing dose (11.3% to 4.3%, p <0.0001), missing frequency (3.5% to 2.2%, p=0.04), missing strength errors (32.4% to 10.2%, p <0.0001) and legibility (0.7% to 0.2%, p=0.005). E-prescriptions, however, were associated with a significant increase in duplication errors, specifically with home medication (1.7% to 3%, p=0.02).

CONCLUSION

A basic, internally developed E-prescription system, featuring commonly used medications, effectively reduced medication errors in a low-resource setting where the costs of sophisticated commercial electronic solutions are prohibitive.

摘要

引言

用药错误很常见,研究报告称每次患者就诊至少会出现一次错误。在医院出院时,用药错误率在15%至38%之间。然而,评估内部开发的电子(E)处方系统在急诊科(ED)出院时效果的研究相对较少。此外,在许多资源有限的环境中,市售的电子解决方案成本过高。我们评估了引入内部开发的低成本电子处方系统(附有常用药物清单)对急诊科出院时处方错误率的影响,并与手写处方进行了比较。

方法

我们进行了一项干预前后研究,比较了在引入电子处方前五个月和后四个月随机抽取的出院处方样本(手写与电子)中的错误率。内部开发的电子处方系统包括166种常用药物的清单,列出了通用名、强度、剂量、频率和疗程。本研究共纳入2883份处方:干预前阶段1475份为手写(HW),干预后阶段140份为电子处方。我们计算了14种不同错误的发生率,并在干预前后进行了比较。

结果

总体而言,与手写处方相比,电子处方中的处方错误较少。具体而言,电子处方减少了漏服剂量(从11.3%降至4.3%,p<0.0001)、漏服频率(从3.5%降至2.2%,p=0.04)、漏写强度错误(从32.4%降至10.2%,p<0.0001)和字迹清晰度问题(从0.7%降至0.2%,p=0.005)。然而,电子处方与重复用药错误的显著增加有关,特别是家庭用药方面(从1.7%增至3%,p=0.02)。

结论

一个基本的、内部开发的电子处方系统,配备常用药物,在资源匮乏的环境中有效减少了用药错误,在这种环境中,复杂的商业电子解决方案成本过高。

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