Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK.
Research Department of Practice and Policy, UCL School of Pharmacy, London, UK.
BMJ Qual Saf. 2018 Jul;27(7):529-538. doi: 10.1136/bmjqs-2017-006631. Epub 2017 Oct 10.
Few studies have applied a systems approach to understanding the causes of specific prescribing errors in the context of hospital electronic prescribing (EP). A comprehensive understanding of underlying causes is essential for developing effective interventions to improve prescribing safety. Our objectives were to explore prescribers' perspectives of the causes of errors occurring with EP and to make recommendations to maximise benefits and minimise risks.
We studied a large hospital using inpatient EP. From April to June 2016, semistructured interviews were conducted with purposively sampled prescribers involved with a prescribing error. Interviews explored prescribers' perceived causes of the error and views about EP; they were audio-recorded and transcribed verbatim. Data were thematically analysed against a framework based on Reason's accident causation model, with a focus on identifying latent conditions.
Twenty-five interviews explored causes of 32 errors. Slips and rule-based mistakes were the most common active failures. Error causation was multifactorial; environmental, individual, team, task and technology error-producing conditions were all influenced by EP. There were three broad groups of latent conditions: the EP system's functionality and design; the organisation's decisions around EP implementation and use; and prescribing behaviours in the context of EP.
Errors were associated with the design of EP itself and its integration within the healthcare environment. Findings suggest that EP vendors should focus on revolutionising interface design and usability issues, bearing in mind the wider healthcare context in which such software is used. Healthcare organisations should draw upon human factors principles when implementing EP. Consideration of work environment, infrastructure, training, prescribing responsibilities and behaviours should be considered to address local issues identified.
在医院电子处方（EP）的背景下，很少有研究采用系统方法来了解特定处方错误的原因。深入了解根本原因对于开发有效的干预措施以提高处方安全性至关重要。我们的目的是探讨医师对 EP 中发生错误的原因的看法，并提出建议，以最大限度地提高收益，同时将风险降到最低。
我们研究了一家使用住院 EP 的大型医院。在 2016 年 4 月至 6 月期间，对参与处方错误的有目的抽样的医师进行了半结构式访谈。访谈探讨了医师对手动处方错误的原因和对 EP 的看法；访谈内容被录音并逐字转录。针对基于 Reason 的事故因果模型的框架对数据进行了主题分析，重点是识别潜在条件。
25 次访谈探讨了 32 次错误的原因。失误和基于规则的错误是最常见的主动失误。错误的原因是多因素的；环境、个人、团队、任务和技术产生错误的条件都受到 EP 的影响。存在三组潜在条件：EP 系统的功能和设计；组织围绕 EP 实施和使用做出的决策；以及在 EP 背景下的处方行为。
这些错误与 EP 本身的设计及其在医疗保健环境中的集成有关。研究结果表明，EP 供应商应专注于彻底改变界面设计和可用性问题，并牢记此类软件在更广泛的医疗保健环境中使用的情况。医疗机构在实施 EP 时应借鉴人为因素原则。应考虑工作环境、基础设施、培训、处方责任和行为，以解决当地确定的问题。
