计算机化医师医嘱录入对处方错误的影响：澳大利亚一家二级转诊医院的中断时间序列研究。

The effect of Computerised Physician Order Entry on prescribing errors: An interrupted time-series study at a secondary referral hospital in Australia.

机构信息

Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland 4029, Australia; Electronic Medicines Management, Digital Metro North, Campbell Place Building 1, Campbell Street, Herston, Queensland 4006, Australia.

Electronic Medicines Management, Digital Metro North, Campbell Place Building 1, Campbell Street, Herston, Queensland 4006, Australia.

出版信息

Int J Med Inform. 2022 Sep;165:104829. doi: 10.1016/j.ijmedinf.2022.104829. Epub 2022 Jul 5.

DOI:10.1016/j.ijmedinf.2022.104829

PMID:35810657

Abstract

BACKGROUND

Computerised Physician Order Entry (CPOE) software is increasingly used across the world to improve medication safety. However, few high-quality studies have reviewed the impact of CPOE on prescribing errors and patient harm.

OBJECTIVE

To investigate the effect of a hybrid CPOE-paper prescribing system on prescribing errors at a secondary hospital site.

DESIGN

An interrupted time-series study was conducted by identifying prescribing errors via prospective medical chart review before and after the implementation of CPOE across three medical wards.

PARTICIPANTS

The medication orders of all patients admitted to the medical wards during the study period were reviewed.

INTERVENTION

Implementation of a CPOE across three medical wards.

MEASURES

A blinded expert panel risk stratified the errors according to level of severity, preventability and potential for harm. Pearson's chi square and segmented regressions were used to determine if there were differences in prescribing errors pre- and post-CPOE implementation.

KEY RESULTS

A total of 10,535 medication orders were reviewed pre-CPOE and 13,841 medication orders reviewed post-CPOE. Analysis demonstrated that after implementation of CPOE there were reductions in the proportion of orders with one or more of any error (-30.1%, 95 %CI: -36.5%, -23.7%, p < 0.001). Reductions in the proportion of orders with one or more errors were seen across the error categories of dosing errors (-20.1%, 95 %CI: -25.1%, -15%, p < 0.001), procedural/administrative errors (-18.9%, 95 %CI: -22.8%, -15%, p < 0.001), and therapeutic errors (-2.6%, 95 %CI: -4.1%, -1%, p = 0.002). Post-CPOE there were reductions in the proportion of orders with at least one non-intercepted serious error (-12.6%, 95 %CI: -16.4%, -8.8%, p < 0.001).

CONCLUSION

The introduction of CPOE was associated with reductions in prescribing errors. There is also evidence that this translated into a reduced risk of harm to patients post-CPOE implementation through the reduction in actual adverse drug events.

摘要

背景

计算机化医嘱录入系统（CPOE）在全球范围内越来越多地用于提高用药安全性。然而，很少有高质量的研究综述了 CPOE 对开具处方错误和患者伤害的影响。

目的

研究在一家二级医院实施混合 CPOE-纸质处方系统对开具处方错误的影响。

设计

通过前瞻性病历审查，在三个医疗病房实施 CPOE 前后，对开具处方错误进行了中断时间序列研究。

参与者

审查了研究期间入住医疗病房的所有患者的医嘱。

干预

在三个医疗病房实施 CPOE。

措施

一个盲法专家小组根据严重程度、可预防程度和潜在伤害程度对错误进行风险分层。采用 Pearson 卡方检验和分段回归分析来确定 CPOE 实施前后开具处方错误是否存在差异。

主要结果

共审查了 10535 份医嘱实施 CPOE 前和 13841 份医嘱实施 CPOE 后。分析表明，实施 CPOE 后，任何错误的医嘱比例降低（30.1%，95%CI：-36.5%，-23.7%，p<0.001）。在剂量错误（20.1%，95%CI：-25.1%，-15%，p<0.001）、程序/管理错误（18.9%，95%CI：-22.8%，-15%，p<0.001）和治疗错误（2.6%，95%CI：-4.1%，-1%，p=0.002）各错误类别中均观察到医嘱比例降低。实施 CPOE 后，至少有一个未拦截的严重错误的医嘱比例降低（12.6%，95%CI：-16.4%，-8.8%，p<0.001）。