Kalfsvel Laura, Wilkes Sarah, van der Kuy Hugo, van den Broek Walter, Zaal Rianne, van Rosse Floor, Versmissen Jorie
Hospital Pharmacy, Erasmus MC, Rotterdam, Netherlands
Hospital Pharmacy, Erasmus MC, Rotterdam, Netherlands.
Eur J Hosp Pharm. 2023 Aug 31. doi: 10.1136/ejhpharm-2023-003859.
Prescribing errors can lead to inconvenience, morbidity and mortality. It is therefore crucial to educate doctors to prescribe safely, efficiently and effectively. To create an effective educational programme, it is essential to understand which errors are made and by whom. The aim of this study is to explore if the experience level of the doctor influences how many and which prescribing errors are made in a European academic teaching hospital, where a computerised physician order entry system (CPOE) with a clinical decision support system (CDSS) is exclusively used.
Prescriptions for all inpatients in an academic teaching hospital were collected in June 2021. All prescriptions with an alert generated by the CDSS which could not be handled by a pharmacy technician according to local protocol were checked for errors. Identified errors were categorised by type and severity.
A total of 130 538 prescriptions were newly made or altered by doctors. Of these prescriptions, 1914 (1.5%) were retained for a check by the pharmacist. These contained 430 prescribing errors (0.3% of total prescriptions). Doctors not in specialty training and those in specialty training made more prescribing errors than consultants (0.5% and 0.5% vs 0.1%; p<0.001). Doctors in specialty training made relatively more drug-drug interaction errors than consultants (n=31 (16%) vs n=3 (3%), p<0.05). No significant difference was found regarding the severity of the errors.
Doctors not in specialty training and doctors in specialty training, who are the less experienced doctors, make more prescribing errors than consultants, even with the use of a CPOE combined with CDSS. The type of errors differ between doctors of different experience levels. This finding provides a solid basis for specific additional education to medical students, doctors not in specialty training and doctors in specialty training.
处方错误可能导致不便、发病和死亡。因此，对医生进行安全、高效和有效开处方的教育至关重要。要创建一个有效的教育计划，了解所犯的错误以及犯错的人是必不可少的。本研究的目的是探讨医生的经验水平是否会影响在一家欧洲学术教学医院中所犯处方错误的数量和类型，该医院专门使用了带有临床决策支持系统（CDSS）的计算机化医生医嘱录入系统（CPOE）。
收集了2021年6月一家学术教学医院所有住院患者的处方。所有由CDSS生成警报且药剂师无法根据当地规程处理的处方都进行了错误检查。识别出的错误按类型和严重程度进行分类。
医生新开具或更改的处方共有130538张。在这些处方中，有1914张（1.5%）被保留以供药剂师检查。这些处方包含430处处方错误（占总处方数的0.3%）。未接受专科培训的医生和接受专科培训的医生比顾问医生犯的处方错误更多（0.5%和0.5%对0.1%；p<0.001）。接受专科培训的医生比顾问医生犯的药物相互作用错误相对更多（n = 31（16%）对n = 3（3%），p<0.05）。在错误的严重程度方面未发现显著差异。
未接受专科培训的医生和接受专科培训的医生，即经验较少的医生，即使使用了CPOE与CDSS相结合的系统，犯的处方错误也比顾问医生多。不同经验水平的医生所犯错误的类型有所不同。这一发现为对医学生、未接受专科培训的医生和接受专科培训的医生进行特定的额外教育提供了坚实的基础。
