Department of Paediatrics and Adolescent Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
Pharmacol Res Perspect. 2023 Jun;11(3):e01092. doi: 10.1002/prp2.1092.
One of the most critical steps in the medication process on pediatric wards is the medical prescription. This study aims to investigate the impact of a computerized physician order entry (CPOE) system on Adverse Drug Events (ADEs) and potentially harmful ADEs (pot ADEs) in comparison with paper-based documentation in a general pediatric ward at a German University hospital.
A prospective pre-post study was conducted. All patients aged 17 years or younger were observed during the study periods (5 months pre- and postimplementation). Issues Regarding Medication (IRM) were identified by intensive chart review. Events were assessed regarding causality (WHO), severity (WHO; Dean & Barber for MEs), and preventability (Shumock) and classified into (pot) ADEs, (pot) Medication errors (ME), Adverse drug Reactions (ADR), and Other incidents (OI) accordingly.
Total of 333 patients with medication were included in the paper-based prescribing cohort (phase I) and 320 patients with medication in the electronic prescribing cohort (phase II). In each cohort, patients received a median number of four different drugs (IQR 5 and IQR 4). A total of 3966 IRM was observed. During the hospitalization, 2.7% (n = 9) patients in phase I and 2.8% (n = 9) in phase II experienced an ADE. Potentially harmful MEs were less often observed in the cohort with electronic prescribing (n = 228 vs. n = 562). The mean number per patient significantly decreased from 1.69 to 0.71 (p < .01).
The implementation of a CPOE system resulted in a reduction of issues regarding medication, particularly MEs with the potential to harm patients decreased significantly.
儿科病房用药流程中最关键的步骤之一是医嘱。本研究旨在比较电子医嘱录入系统（CPOE）与纸质医嘱在德国大学附属医院普通儿科病房对药物不良事件（ADE）和潜在有害 ADE（pot ADE）的影响。
前瞻性的前后对照研究。在研究期间（实施前 5 个月和实施后 5 个月）观察所有 17 岁及以下的患者。通过密集的图表审查发现用药问题（IRM）。根据世界卫生组织（WHO）评估事件的因果关系、严重程度（WHO；Dean & Barber 用于 ME）和可预防程度（Shumock），并将其分类为（pot）ADE、（pot）用药错误（ME）、药物不良反应（ADR）和其他事件（OI）。
共纳入 333 名接受药物治疗的患者进入纸质医嘱组（I 期），320 名接受药物治疗的患者进入电子医嘱组（II 期）。在每个队列中，患者接受中位数为 4 种不同药物（IQR 5 和 IQR 4）。共观察到 3966 个 IRM。住院期间，I 期有 2.7%（n=9）的患者和 II 期有 2.8%（n=9）的患者发生 ADE。电子医嘱组潜在有害 ME 发生率较低（n=228 比 n=562）。每位患者的平均数量从 1.69 显著减少至 0.71（p<.01）。
实施 CPOE 系统后，用药问题减少，特别是有潜在危害患者的 ME 显著减少。
