Garrod Mathew, Fox Andy, Rutter Paul
Department of Pharmacy, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
School of Pharmacy and Biomedical Science, University of Portsmouth, Portsmouth, UK.
JAMIA Open. 2023 Aug 2;6(3):ooad057. doi: 10.1093/jamiaopen/ooad057. eCollection 2023 Oct.
To investigate: (1) what automated search methods are used to identify wrong-patient order entry (WPOE), (2) what data are being captured and how they are being used, (3) the causes of WPOE, and (4) how providers identify their own errors.
A systematic scoping review of the empirical literature was performed using the databases CINAHL, Embase, and MEDLINE, covering the period from database inception until 2021. Search terms were related to the use of automated searches for WPOE when using an electronic prescribing system. Data were extracted and thematic analysis was performed to identify patterns or themes within the data.
Fifteen papers were included in the review. Several automated search methods were identified, with the retract-and-reorder (RAR) method and the Void Alert Tool (VAT) the most prevalent. Included studies used automated search methods to identify background error rates in isolation, or in the context of an intervention. Risk factors for WPOE were identified, with technological factors and interruptions deemed the biggest risks. Minimal data on how providers identify their own errors were identified.
RAR is the most widely used method to identify WPOE, with a good positive predictive value (PPV) of 76.2%. However, it will not currently identify other error types. The VAT is nonspecific for WPOE, with a mean PPV of 78%-93.1%, but the voiding reason accuracy varies considerably.
Automated search methods are powerful tools to identify WPOE that would otherwise go unnoticed. Further research is required around self-identification of errors.
调查:(1)用于识别患者医嘱录入错误(WPOE)的自动搜索方法有哪些;(2)正在收集哪些数据以及如何使用这些数据;(3)WPOE的原因;(4)医疗服务提供者如何识别自己的错误。
使用CINAHL、Embase和MEDLINE数据库对实证文献进行系统的范围综述,涵盖从数据库建立到2021年的时间段。搜索词与在使用电子处方系统时对WPOE进行自动搜索的应用相关。提取数据并进行主题分析,以识别数据中的模式或主题。
该综述纳入了15篇论文。确定了几种自动搜索方法,其中撤回并重新排序(RAR)方法和无效警报工具(VAT)最为普遍。纳入的研究使用自动搜索方法单独或在干预背景下识别背景错误率。确定了WPOE的风险因素,技术因素和干扰被认为是最大的风险。关于医疗服务提供者如何识别自己错误的相关数据极少。
RAR是识别WPOE最广泛使用的方法,具有良好的阳性预测值(PPV),为76.2%。然而,它目前无法识别其他错误类型。VAT对WPOE不具有特异性,平均PPV为78%-93.1%,但无效原因的准确性差异很大。
自动搜索方法是识别否则可能会被忽视的WPOE的有力工具。围绕错误的自我识别还需要进一步研究。