Yin Xuwen, Song Haiyan, Lu Jieyu, Yang Jing, Wang Rong, Lin Zheng, Jiang Shudi, Yuan Hui, Wang Xumei, Xu Dongmei, Gao Chunhong, Zhou Yuan, Xu Jiayi, Chen Chen, Gu Chenyu, Diao Qingqing, Li Fang, Gu Zejuan
School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China.
Department of Nursing, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Ther Adv Drug Saf. 2024 Oct 13;15:20420986241288421. doi: 10.1177/20420986241288421. eCollection 2024.
Closed-loop electronic medication management systems are effective measures for preventing medication errors (MEs). However, there is limited evidence supporting this, and few studies have evaluated the long-term effects of these systems on safe medication.
To evaluate the long-term effects of implementing a closed-loop medication order executive system on the safe clinical use of medications.
A quasi-experimental design.
Data from 2017 to 2023 were extracted and retrospectively analyzed. The primary outcome indicator was the ME rate. Secondary outcome indicators were the accuracy of order verification and patient identification and the implementation rate of fresh medicine dispensing. The autoregressive integrated moving average (ARIMA) model in time-series analysis was used to evaluate the level and trend changes in ME rates using SPSS 25.0 before and after system implementation. Root cause analysis and descriptive statistics were used to assess changes in types, stages, and causes of ME rates. The independent samples -test was used to analyze secondary outcomes.
Overall, 295 MEs were reported with a mean of 0.26 ± 0.26 ME rates per month during 2017-2023. The ARIMA model showed a decrease in the average level of ME rates after system implementation, with no statistically significant decrease in the long term, and a significant drop in the ME rate in the short and medium term ( < 0.01). Nurses' administration accounted for more than 60% of errors post-implementation, and lack of communication was a prominent factor. The accuracy of order verification and patient identification and the implementation rate of fresh medicine dispensing all increased after implementation.
Adopting a closed-loop executive system is beneficial for ensuring patient medication safety, but a single integrated system does not completely eliminate MEs. Optimizing system functionalities and applying structured handoff tools are recommended to meet clinical needs and enhance system usability.
闭环电子药物管理系统是预防用药错误（MEs）的有效措施。然而，支持这一观点的证据有限，很少有研究评估这些系统对安全用药的长期影响。
评估实施闭环医嘱执行系统对药物安全临床使用的长期影响。
准实验设计。
提取并回顾性分析2017年至2023年的数据。主要结局指标是用药错误率。次要结局指标是医嘱核对和患者识别的准确性以及新鲜药物调配的执行率。使用时间序列分析中的自回归积分移动平均（ARIMA）模型，在系统实施前后，采用SPSS 25.0评估用药错误率的水平和趋势变化。采用根本原因分析和描述性统计评估用药错误率的类型、阶段和原因的变化。使用独立样本t检验分析次要结局。
总体而言，2017 - 2023年期间共报告了295例用药错误，每月平均用药错误率为0.26±0.26。ARIMA模型显示系统实施后用药错误率的平均水平有所下降，长期来看下降无统计学意义，但在短期和中期用药错误率显著下降（<0.01）。实施后护士给药错误占比超过60%，沟通不畅是一个突出因素。实施后医嘱核对和患者识别的准确性以及新鲜药物调配的执行率均有所提高。
采用闭环执行系统有利于确保患者用药安全，但单一的集成系统并不能完全消除用药错误。建议优化系统功能并应用结构化交接工具，以满足临床需求并提高系统可用性。
