Pharmacy Department, North Hospital, Public Hospitals of Marseille, France.
Pharmacy Department, North Hospital, Public Hospitals of Marseille, France.
Int J Med Inform. 2022 Apr;160:104703. doi: 10.1016/j.ijmedinf.2022.104703. Epub 2022 Jan 21.
Computerised prescriptions for Hospital Discharge Orders (HDO) are used world-wide to secure medication processes.
To evaluate physicians' adoption of computerised provider order-entry (CPOE) for HDO and the prescribing error rate of HDO in an acute medical care unit.
A prospective study was conducted in an internal medicine department over a six-month period. The use rate of CPOE for HDO edition, prescription lines concordance between CPOE-edited HDO, exit prescriptions transcribed in the discharge summary (DS), and prescribing error rate in CPOE-edited HDO were all evaluated.
A total of 407 patients with HDO were included in the study. HDO were edited via CPOE system for 350 patients (86%), among which 124 (35%) were identically transcribed, 217 (62%) had discrepancies, and nine (3%) were not transcribed in the discharge summary (DS). Prescription errors were analysed using the total of 2,854 drugs prescribed on HDO. Although hospital pharmacists had signalled discrepancies and provided recommendations to the prescribers via alerting pharmaceutical interventions in CPOE 67 prescription errors (error rate of 2.3%) were found. Errors included 53 cases of refractory period disrespected, four cases of drug interactions, three cases of drug redundancies, and two cases of excessive dosage.
This study highlights that most HDO were edited via the CPOE system. Together with pharmacist's interventions, the CPOE system contributed to reducing the prescription error rate in HDO. However, discrepancies in the recording process to DS were frequent, calling for reinforcement of error prevention strategies upon the integration of a CPOE system in the hospital's Electronic Health Records. Providing regular training for physicians is also a requirement.
计算机化的出院医嘱（HDO）在全球范围内用于确保药物治疗过程的安全。
评估医生对 HDO 的计算机化医嘱录入（CPOE）的采用情况以及内科病房 HDO 的处方错误率。
在六个月的时间里，在内科部门进行了一项前瞻性研究。评估了 HDO 版本的 CPOE 使用率、CPOE 编辑的 HDO 与出院小结（DS）中转录的医嘱之间的医嘱行一致性以及 CPOE 编辑的 HDO 中的处方错误率。
共有 407 名 HDO 患者纳入研究。有 350 名患者（86%）通过 CPOE 系统编辑了 HDO，其中 124 名（35%）被完全转录，217 名（62%）有差异，9 名（3%）未转录到 DS 中。使用 HDO 上开的 2854 种药物进行了处方错误分析。尽管医院药剂师通过 CPOE 中的警报药物干预向开方者发出了差异和建议，但仍发现了 67 个处方错误（错误率为 2.3%）。错误包括 53 例不遵守半衰期的情况、4 例药物相互作用、3 例药物冗余和 2 例剂量过大。
本研究表明，大多数 HDO 通过 CPOE 系统编辑。通过药剂师的干预，CPOE 系统有助于降低 HDO 的处方错误率。然而，DS 记录过程中的差异很频繁，这要求在医院的电子病历中整合 CPOE 系统时加强错误预防策略，并对医生进行定期培训。
