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计算机化医师医嘱录入对处方医嘱的影响:伊朗的一项准实验研究。

The impact of computerized physician order entry on prescription orders: A quasi-experimental study in Iran.

作者信息

Khammarnia Mohammad, Sharifian Roxana, Zand Farid, Barati Omid, Keshtkaran Ali, Sabetian Golnar, Shahrokh Nasim, Setoodezadeh Fatemeh

机构信息

Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.

Department of Health Information Management, School of Management and Medical Information Sciences, Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

出版信息

Med J Islam Repub Iran. 2017 Oct 3;31:69. doi: 10.14196/mjiri.31.69. eCollection 2017.

Abstract

One way to reduce medical errors associated with physician orders is computerized physician order entry (CPOE) software. This study was conducted to compare prescription orders between 2 groups before and after CPOE implementation in a hospital. We conducted a before-after prospective study in 2 intensive care unit (ICU) wards (as intervention and control wards) in the largest tertiary public hospital in South of Iran during 2014 and 2016. All prescription orders were validated by a clinical pharmacist and an ICU physician. The rates of ordering the errors in medical orders were compared before (manual ordering) and after implementation of the CPOE. A standard checklist was used for data collection. For the data analysis, SPSS Version 21, descriptive statistics, and analytical tests such as McNemar, chi-square, and logistic regression were used. The CPOE significantly decreased 2 types of errors, illegible orders and lack of writing the drug form, in the intervention ward compared to the control ward (p< 0.05); however, the 2 errors increased due to the defect in the CPOE (p< 0.001). The use of CPOE decreased the prescription errors from 19% to 3% (p= 0.001), However, no differences were observed in the control ward (p<0.05). In addition, more errors occurred in the morning shift (p< 0.001). In general, the use of CPOE significantly reduced the prescription errors. Nonetheless, more caution should be exercised in the use of this system, and its deficiencies should be resolved. Furthermore, it is recommended that CPOE be used to improve the quality of delivered services in hospitals.

摘要

减少与医生医嘱相关的医疗差错的一种方法是使用计算机化医生医嘱录入(CPOE)软件。本研究旨在比较一家医院实施CPOE前后两组的处方医嘱。2014年至2016年期间,我们在伊朗南部最大的三级公立医院的2个重症监护病房(ICU)(作为干预病房和对照病房)进行了一项前后瞻性研究。所有处方医嘱均由临床药剂师和ICU医生进行验证。比较了CPOE实施前(手工开医嘱)和实施后医疗医嘱中的开错率。使用标准检查表收集数据。数据分析使用SPSS 21版、描述性统计以及McNemar检验、卡方检验和逻辑回归等分析测试。与对照病房相比,CPOE显著减少了干预病房中字迹模糊的医嘱和未写明剂型这两种差错(p<0.05);然而,由于CPOE的缺陷,这两种差错有所增加(p<0.001)。CPOE的使用使处方差错率从19%降至3%(p=0.001),然而,对照病房未观察到差异(p<0.05)。此外,早班发生的差错更多(p<0.001)。总体而言,CPOE的使用显著减少了处方差错。尽管如此,在使用该系统时应更加谨慎,并解决其不足之处。此外,建议使用CPOE来提高医院提供的服务质量。

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