Bowers Tayla R, Duffy Eamon J
Whangarei Hospital, New Zealand.
Auckland City Hospital, New Zealand.
Health Informatics J. 2020 Dec;26(4):2375-2382. doi: 10.1177/1460458220905163. Epub 2020 Feb 20.
Improving antimicrobial prescribing is a difficult process often requiring labour-intensive, multi-modal interventions. Many hospitals have introduced ePrescribing systems but the effect on antimicrobial prescribing, without treatment choice decision support systems, has not been well described. We sought to determine whether the introduction of ePrescribing improved prescribing quality. Patient records for inpatients on four rehabilitation wards, two using ePrescribing and two using the National Medication Chart, during February 2017, were retrospectively reviewed to identify all antimicrobial prescriptions, which were then reviewed for quality. Documentation of indication was significantly better on ePrescribing wards (45/46, 98%) compared to National Medication Chart wards (47/59, 80%). Adherence to guidelines (32/46, 70% vs 33/59, 56%), appropriateness of therapy (42/46, 91% vs 50/59, 85%) and documentation of duration, stop or review dates (35/46, 76% vs 38/59, 64%) did not significantly differ. ePrescribing can improve the quality of antimicrobial prescribing when Antimicrobial Stewardship principles are used in system customisation but cannot address all factors impacting on prescribing quality.
改善抗菌药物处方是一个困难的过程，通常需要耗费大量人力的多模式干预措施。许多医院已经引入了电子处方系统，但在没有治疗选择决策支持系统的情况下，其对抗菌药物处方的影响尚未得到充分描述。我们试图确定引入电子处方是否能提高处方质量。对2017年2月四个康复病房住院患者的病历进行回顾性审查，其中两个病房使用电子处方，两个病房使用国家药物图表，以识别所有抗菌药物处方，然后对其质量进行审查。与使用国家药物图表的病房（47/59，80%）相比，电子处方病房的用药指征记录明显更好（45/46，98%）。在遵循指南方面（32/46，70%对33/59，56%）、治疗的适当性（42/46，91%对50/59，85%）以及疗程、停药或复查日期的记录方面（35/46，76%对38/59，64%）没有显著差异。当在系统定制中运用抗菌药物管理原则时，电子处方可以提高抗菌药物处方的质量，但无法解决影响处方质量的所有因素。
