Sowan Azizeh Khaled, Vera Ana, Malshe Ashwin, Reed Charles
School of Nursing, University of Texas Health at San Antonio, San Antonio, TX, United States.
Center for Clinical Excellence, University Health System, San Antonio, TX, United States.
JMIR Med Inform. 2019 Mar 25;7(1):e11873. doi: 10.2196/11873.
Critically ill patients require constant point-of-care blood glucose testing to guide insulin-related decisions. Transcribing these values from glucometers into a paper log and the electronic medical record is very common yet error-prone in intensive care units, given the lack of connectivity between glucometers and the electronic medical record in many US hospitals.
We examined (1) transcription errors of glucometer blood glucose values documented in the paper log and in the electronic medical record vital signs flow sheet in a surgical trauma intensive care unit, (2) insulin errors resulting from transcription errors, (3) lack of documenting these values in the paper log and the electronic medical record vital signs flow sheet, and (4) average time for docking the glucometer.
This secondary data analysis examined 5049 point-of-care blood glucose tests. We obtained values of blood glucose tests from bidirectional interface software that transfers the meters' data to the electronic medical record, the paper log, and the vital signs flow sheet. We obtained patient demographic and clinical-related information from the electronic medical record.
Of the 5049 blood glucose tests, which were pertinent to 234 patients, the total numbers of undocumented or untranscribed tests were 608 (12.04%) in the paper log, 2064 (40.88%) in the flow sheet, and 239 (4.73%) in both. The numbers of transcription errors for the documented tests were 98 (2.21% of 4441 documented tests) in the paper log, 242 (8.11% of 2985 tests) in the flow sheet, and 43 (1.64% of 2616 tests) in both. The numbers of transcription errors per patient were 0.4 (98 errors/234 patients) in the paper log, 1 (242 errors/234 patients) in the flow sheet, and 0.2 in both (43 errors/234 patients). Transcription errors in the paper log, the flow sheet, and in both resulted in 8, 24, and 2 insulin errors, respectively. As a consequence, patients were given a lower or higher insulin dose than the dose they should have received had there been no errors. Discrepancies in insulin doses were 2 to 8 U lower doses in paper log transcription errors, 10 U lower to 3 U higher doses in flow sheet transcription errors, and 2 U lower in transcription errors in both. Overall, 30 unique insulin errors affected 25 of 234 patients (10.7%). The average time from point-of-care testing to meter docking was 8 hours (median 5.5 hours), with some taking 56 hours (2.3 days) to be uploaded.
Given the high dependence on glucometers for point-of-care blood glucose testing in intensive care units, full electronic medical record-glucometer interoperability is required for complete, accurate, and timely documentation of blood glucose values and elimination of transcription errors and the subsequent insulin-related errors in intensive care units.
重症患者需要持续进行即时血糖检测，以指导与胰岛素相关的决策。在美国许多医院，由于血糖仪与电子病历之间缺乏连接，将血糖仪测得的值转录到纸质日志和电子病历中在重症监护病房非常普遍，但容易出错。
我们研究了（1）外科创伤重症监护病房纸质日志和电子病历生命体征流程图中记录的血糖仪血糖值的转录错误，（2）转录错误导致的胰岛素错误，（3）纸质日志和电子病历生命体征流程图中未记录这些值的情况，以及（4）血糖仪对接的平均时间。
这项二次数据分析检查了5049次即时血糖检测。我们从双向接口软件中获取血糖检测值，该软件将血糖仪数据传输到电子病历、纸质日志和生命体征流程图中。我们从电子病历中获取患者人口统计学和临床相关信息。
在与234名患者相关的5049次血糖检测中，纸质日志中未记录或未转录的检测总数为608次（12.04%），流程图中为2064次（40.88%），两者均未记录的为239次（4.73%）。记录的检测中，纸质日志中的转录错误有98次（占4441次记录检测的2.21%），流程图中有242次（占2985次检测的8.11%），两者均有的有43次（占2616次检测的1.64%）。每位患者的转录错误数在纸质日志中为0.4次（98次错误/234名患者），流程图中为1次（242次错误/234名患者），两者均有的为0.2次（43次错误/234名患者）。纸质日志、流程图以及两者中的转录错误分别导致8次、24次和2次胰岛素错误。因此，与没有错误时相比，患者接受的胰岛素剂量更低或更高。纸质日志转录错误导致胰岛素剂量低2至8单位，流程图转录错误导致剂量低10单位至高3单位，两者中的转录错误导致剂量低2单位。总体而言，30次独特的胰岛素错误影响了234名患者中的25名（10.7%）。从即时检测到血糖仪对接的平均时间为8小时（中位数为5.5小时），有些需要56小时（2.3天）才能上传。
鉴于重症监护病房对血糖仪进行即时血糖检测的高度依赖，重症监护病房需要完整的电子病历与血糖仪的互操作性，以完整、准确和及时地记录血糖值，并消除转录错误以及随后的与胰岛素相关的错误。
