Burlison Jonathan D, McDaniel Robert B, Baker Donald K, Hasan Murad, Robertson Jennifer J, Howard Scott C, Hoffman James M
Appl Clin Inform. 2018 Jan;9(1):82-88. doi: 10.1055/s-0037-1621703. Epub 2018 Jan 31.
Previous research developed a new method for locating prescribing errors in rapidly discontinued electronic medication orders. Although effective, the prospective design of that research hinders its feasibility for regular use.
Our objectives were to assess a method to retrospectively detect prescribing errors, to characterize the identified errors, and to identify potential improvement opportunities.
Electronically submitted medication orders from 28 randomly selected days that were discontinued within 120 minutes of submission were reviewed and categorized as most likely errors, nonerrors, or not enough information to determine status. Identified errors were evaluated by amount of time elapsed from original submission to discontinuation, error type, staff position, and potential clinical significance. Pearson's chi-square test was used to compare rates of errors across prescriber types.
In all, 147 errors were identified in 305 medication orders. The method was most effective for orders that were discontinued within 90 minutes. Duplicate orders were most common; physicians in training had the highest error rate ( < 0.001), and 24 errors were potentially clinically significant. None of the errors were voluntarily reported.
It is possible to identify prescribing errors in rapidly discontinued medication orders by using retrospective methods that do not require interrupting prescribers to discuss order details. Future research could validate our methods in different clinical settings. Regular use of this measure could help determine the causes of prescribing errors, track performance, and identify and evaluate interventions to improve prescribing systems and processes.
先前的研究开发了一种新方法，用于在快速停用的电子用药医嘱中定位开方错误。尽管该方法有效，但其前瞻性设计阻碍了其常规使用的可行性。
我们的目的是评估一种回顾性检测开方错误的方法，对识别出的错误进行特征描述，并确定潜在的改进机会。
对从28个随机选择的日期中电子提交且在提交后120分钟内停用的用药医嘱进行审查，并分类为极有可能是错误、非错误或信息不足无法确定状态。对识别出的错误，根据从原始提交到停用所经过的时间、错误类型、工作人员职位以及潜在的临床意义进行评估。使用Pearson卡方检验比较不同开方者类型的错误发生率。
总共在305条用药医嘱中识别出147个错误。该方法对在90分钟内停用的医嘱最为有效。重复医嘱最为常见；实习医生的错误率最高（<0.001），并且有24个错误可能具有临床意义。没有一个错误是被主动报告的。
通过使用回顾性方法，可以在快速停用的用药医嘱中识别开方错误，这种方法无需打断开方者来讨论医嘱细节。未来的研究可以在不同临床环境中验证我们的方法。定期使用该措施有助于确定开方错误的原因、跟踪绩效，以及识别和评估改善开方系统和流程的干预措施。
