The impact of computerized physician order entry on medication error prevention
The impact of computerized physician order entry on medication error prevention
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DOI：
10.1136/jamia.1999.00660313
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发表时间：
1999-07-01
影响因子：
6.4
通讯作者：
Leape, L
中科院分区：
文献类型：
--
作者：
Bates, DW;Teich, JM;Leape, L
背景：用药差错很常见，虽然大多数这样的差错几乎没有潜在的危害，但它们会在医院造成大量额外的工作。目的：评估计算机医嘱录入(POE)在减少用药差错数量方面的影响。设计：前瞻性时间序列分析，共4个周期。背景和对象：对4个不同年份在3个医疗单位住院的所有患者进行了7至10周的研究。基准期是在实施PoE之前，其余三个是在实施PoE之后。POE的复杂性随着每个连续阶段的进展而增加。干预：医嘱输入具有决策支持功能，例如药物过敏和药物-药物相互作用警告。主要结果：用药错误，不包括错过剂量的错误。结果：在研究期间，非错过剂量的用药错误率下降了81%，从基准期的每千人日142次下降到末期的每千人日26.6次(P<；0.0001)。未截获的严重用药差错(有可能造成伤害的差错)比基线下降了86%，降至第三阶段，即最后阶段(P=0.0003)。所有主要类型的用药错误都有很大的差异：剂量错误、频率错误、路线错误、替代错误和过敏。例如，在基线期间，有10个过敏错误，但在接下来的三个时期加在一起只有两个(P<；0.0001)。结论：计算机化的POE显著降低了非漏量用药错误的发生率。该系统的初始版本大大减少了错误，增加了决策支持功能，进一步减少了错误。
Background: Medication errors are common, and while most such errors have little potential for harm they cause substantial extra work in hospitals. A small proportion do have the potential to cause injury, and some cause preventable adverse drug events.Objective: To evaluate the impact of computerized physician order entry (POE) with decision support in reducing the number of medication errors.Design: Prospective time series analysis, with four periods.Setting and participants: All patients admitted to three medical units were studied for seven to ten-week periods in four different years. The baseline period was before implementation of POE, and the remaining three were after. Sophistication of POE increased with each successive period.Intervention: Physician order entry with decision support features such as drug allergy and drug-drug interaction warnings.Main outcome measure: Medication errors, excluding missed dose errors.Results: During the study, the non-missed-dose medication error rate fell 81 percent, from 142 per 1,000 patient-days in the baseline period to 26.6 per 1,000 patient-days in the final period (P < 0.0001). Non-intercepted serious medication errors (those with the potential to cause injury) fell 86 percent from baseline to period 3, the final period (P = 0.0003). Large differences were seen for all main types of medication errors: dose errors, frequency errors, route errors, substitution errors, and allergies. For example, in the baseline period there were ten allergy errors, but only two in the following three periods combined (P < 0.0001).Conclusions: Computerized POE substantially decreased the rate of non-missed-dose medication errors. A major reduction in errors was achieved with th initial version of the system, and further reductions were found with addition of decision support features.