Georges Pompidou European Hospital, Clinical Pharmacy Department, Paris, France; Paris-Sud University, Faculty of Pharmacy, Clinical Pharmacy Department, EA 4123, Châtenay-Malabry, France.
Georges Pompidou European Hospital, Medical Informatics Department, Paris, France; Université Paris Descartes, INSERM UMR 1138 équipe 22, Centre de Recherche des Cordeliers, Paris, France.
Int J Med Inform. 2018 Mar;111:112-122. doi: 10.1016/j.ijmedinf.2017.12.022. Epub 2017 Dec 28.
The positive impact of computerized physician order entry (CPOE) systems on prescription safety must be considered in light of the persistence of certain types of medication-prescription errors. We performed a systematic review, based on the PRISMA statement, to analyze the prevalence of prescription errors related to the use of CPOE systems.
We searched MEDLINE, EMBASE, CENTRAL, DBLP, the International Clinical Trials Registry, the ISI Web of Science, and reference lists of relevant articles from March 1982 to August 2017. We included original peer-reviewed studies which quantitatively reported medication-prescription errors related to CPOE. We analyzed the prevalence of medication-prescription errors according to an adapted version of the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) taxonomy and assessed the mechanisms responsible for each type of prescription error due to CPOE.
Fourteen studies were included. The prevalence of CPOE systems-related medication errors relative to all prescription medication errors ranged from 6.1 to 77.7% (median = 26.1% [IQR:17.6-42,1]) and was less than 6.3% relative to the number of prescriptions reviewed. All studies reported "wrong dose" and "wrong drug" errors. The "wrong dose" error was the most frequently reported (from 7 to 67.4%, median = 31.5% [IQR:20.5-44.5]). We report the associated mechanism for each type of medication described (those due to CPOE or those occurring despite CPOE).
We observed very heterogeneous results, probably due to the definition of error, the type of health information system used for the study, and the data collection method used. Each data collection method provides valuable and useful information concerning the prevalence and specific types of errors related to CPOE systems.
The reporting of prescription errors should be continued because the weaknesses of CPOE systems are potential sources of error. Analysis of the mechanisms behind CPOE errors can reveal areas for improvement.
鉴于某些类型的用药处方错误仍然存在，必须考虑计算机化医嘱录入（CPOE）系统对处方安全性的积极影响。我们根据 PRISMA 声明进行了系统评价，以分析与 CPOE 系统使用相关的处方错误的发生率。
我们检索了 MEDLINE、EMBASE、CENTRAL、DBLP、国际临床试验注册平台、ISI Web of Science 和相关文章的参考文献列表，检索时间从 1982 年 3 月到 2017 年 8 月。我们纳入了定量报告与 CPOE 相关的用药处方错误的原始同行评审研究。我们根据国家药物错误报告与预防协调委员会（NCCMERP）分类法的改编版分析了用药处方错误的发生率，并评估了由于 CPOE 导致每种类型处方错误的机制。
纳入了 14 项研究。CPOE 系统相关用药错误相对于所有处方用药错误的发生率为 6.1%至 77.7%（中位数 26.1% [IQR：17.6-42，1]），相对于审查的处方数量的发生率小于 6.3%。所有研究均报告了“剂量错误”和“药物错误”。“剂量错误”是最常报告的错误（发生率为 7%至 67.4%，中位数 31.5% [IQR：20.5-44.5]）。我们报告了与每种描述的用药相关的机制（由于 CPOE 引起的或尽管有 CPOE 仍发生的）。
我们观察到非常异质的结果，这可能是由于错误的定义、用于研究的健康信息系统的类型以及使用的数据收集方法所致。每种数据收集方法都提供了有关与 CPOE 系统相关的错误的发生率和特定类型的有价值和有用的信息。
由于 CPOE 系统的弱点可能是错误的来源，因此应继续报告处方错误。对 CPOE 错误背后的机制进行分析可以揭示改进的领域。
