Rouayroux Naïs, Calmels Violaine, Bachelet Bérengére, Sallerin Brigitte, Divol Elodie
Clinical Pharmacy Department, Toulouse University Hospital Centre, 1 Avenue du Professeur Jean Poulhès, 31059, Toulouse, France.
Int J Clin Pharm. 2019 Feb;41(1):228-236. doi: 10.1007/s11096-018-0747-0. Epub 2018 Nov 16.
Background The computerization of prescriptions with a computerized physician order entry contributes to securing the error-free drug supply, but is not risk-free. Objective: To determine the impact of a computerized physician order entry system on prescribing errors immediately after its implementation and 1 year later. Setting The Cardiology and Diabetology Departments at Toulouse University Hospital, France. Method The prescriptions were analysed by pharmacists over three 30-day periods for 3 consecutive years (N: computerization period, N - 1, N + 1). For each identified error, the prescriber was informed by a pharmaceutical intervention. The pharmaceutical interventions were counted and arranged according to the classification by the French Society of Clinical Pharmacy. Their average numbers and clinical impacts were compared for each period using t-tests and Kruskal-Wallis tests. Main outcome measure The average numbers of pharmaceutical interventions. Results In total, 12.1 pharmaceutical interventions per 100 patient days were done during the N - 1 period, 14.1 during N and 9.6 during N + 1. Among those, 3.6 (N) and 2.1 (N + 1) were related to the computerization itself, and 10.5 (N) and 7.5 (N + 1) were not. The average number of computerization-related pharmaceutical interventions significantly decreased from N to N + 1 (p = 0.04). The average number of classic interventions decreased from N - 1 to N + 1 (p = 0.02). The clinical impacts of the computerization related errors were similar to those of other errors. Conclusion The implementation of the computerized physician order entry induced the appearance of specific computerized-related errors, but the number of classic errors decreased. The entry-system related errors were not more severe than other errors, and the number decreased after 1 year.
计算机化医嘱录入实现处方电子化有助于确保药品供应无差错，但并非毫无风险。目的：确定计算机化医嘱录入系统在实施后即刻及1年后对处方错误的影响。地点：法国图卢兹大学医院心内科和糖尿病科。方法：连续3年，药剂师在三个30天时间段内分析处方（N：计算机化阶段，N - 1，N + 1）。对于每一个识别出的错误，通过药学干预告知开方者。统计药学干预次数，并根据法国临床药学协会的分类进行整理。使用t检验和Kruskal-Wallis检验比较各时间段的平均干预次数及其临床影响。主要观察指标：药学干预的平均次数。结果：在N - 1阶段，每100患者日进行12.1次药学干预，N阶段为14.1次，N + 1阶段为9.6次。其中，与计算机化本身相关的干预在N阶段为3.6次，N + 1阶段为2.1次；与计算机化无关的干预在N阶段为10.5次，N + 1阶段为7.5次。与计算机化相关的药学干预平均次数从N阶段到N + 1阶段显著减少（p = 0.04）。经典干预的平均次数从N - 1阶段到N + 1阶段减少（p = 0.02）。计算机化相关错误的临床影响与其他错误相似。结论：计算机化医嘱录入的实施导致了特定的与计算机化相关错误的出现，但经典错误的数量减少。与录入系统相关的错误并不比其他错误更严重，且1年后数量减少。
