Transcription Errors of Blood Glucose Values and Insulin Errors in an Intensive Care Unit: Secondary Data Analysis Toward Electronic Medical Record-Glucometer Interoperability
Transcription Errors of Blood Glucose Values and Insulin Errors in an Intensive Care Unit: Secondary Data Analysis Toward Electronic Medical Record-Glucometer Interoperability
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DOI：
10.2196/11873
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发表时间：
2019-01-01
影响因子：
3.2
通讯作者：
Reed, Charles
中科院分区：
文献类型：
--
作者：
Sowan, Azizeh Khaled;Vera, Ana;Reed, Charles
背景：危重患者需要持续的床旁血糖检测来指导胰岛素相关决策。在重症监护室，将血糖仪的这些值转换为纸质日志和电子病历非常常见，但容易出错，因为在许多美国医院，血糖仪和电子病历之间缺乏连接。目的：我们研究了（1）手术创伤中纸质日志和电子病历生命体征流程表中记录的血糖仪血糖值的转录错误重症监护室，（2）胰岛素错误导致的转录错误，（3）缺乏记录这些值在纸日志和电子病历生命体征流程表，和（4）对接的glucometer.Methods的平均时间：这二次数据分析检查了5049点的护理血糖测试。我们从双向接口软件中获取血糖检测值，该软件将血糖仪数据传输到电子病历、纸质日志和生命体征流程表。我们从电子病历中获得了患者的人口统计学和临床相关信息。结果：在与234例患者相关的5049次血糖检测中，纸质日志中未记录或未转录的检测总数为608次（12.04%），流程表中为2064次（40.88%），两者均为239次（4.73%）。记录的测试的转录错误数量在纸质日志中为98个（占4441个记录测试的2.21%），在流程图中为242个（占2985个测试的8.11%），在两者中均为43个（占2616个测试的1.64%）。纸质日志中每例患者的转录错误数量为0.4（98个错误/234例患者），流程表中为1（242个错误/234例患者），两者均为0.2（43个错误/234例患者）。纸质日志、流程表和两者中的转录错误分别导致8、24和2例胰岛素错误。因此，患者接受的胰岛素剂量低于或高于他们在没有错误的情况下应该接受的剂量。胰岛素剂量的差异性为纸记录转录错误中低剂量2至8 U，流程表转录错误中低剂量10 U至高剂量3 U，两种情况下的转录错误均低2 U。总体而言，30例独特的胰岛素错误影响了234例患者中的25例（10.7%）。从即时检测到血糖仪对接的平均时间为8小时（中位数5.5小时），有些人需要56小时（2.3天）上传。结论：鉴于重症监护病房中的床旁血糖检测高度依赖血糖仪，因此需要完整的电子病历-血糖仪互操作性，以及及时记录血糖值和消除转录错误以及随后在重症监护室中的胰岛素相关错误。
Background: Critically ill patients require constant point-of-care blood glucose testing to guide insulin-related decisions. Transcribing these values from glucometers into a paper log and the electronic medical record is very common yet error-prone in intensive care units, given the lack of connectivity between glucometers and the electronic medical record in many US hospitals.Objective: We examined (1) transcription errors of glucometer blood glucose values documented in the paper log and in the electronic medical record vital signs flow sheet in a surgical trauma intensive care unit, (2) insulin errors resulting from transcription errors, (3) lack of documenting these values in the paper log and the electronic medical record vital signs flow sheet, and (4) average time for docking the glucometer.Methods: This secondary data analysis examined 5049 point-of-care blood glucose tests. We obtained values of blood glucose tests from bidirectional interface software that transfers the meters' data to the electronic medical record, the paper log, and the vital signs flow sheet. We obtained patient demographic and clinical-related information from the electronic medical record.Results: Of the 5049 blood glucose tests, which were pertinent to 234 patients, the total numbers of undocumented or untranscribed tests were 608 (12.04%) in the paper log, 2064 (40.88%) in the flow sheet, and 239 (4.73%) in both. The numbers of transcription errors for the documented tests were 98 (2.21% of 4441 documented tests) in the paper log, 242 (8.11% of 2985 tests) in the flow sheet, and 43 (1.64% of 2616 tests) in both. The numbers of transcription errors per patient were 0.4 (98 errors/234 patients) in the paper log, 1 (242 errors/234 patients) in the flow sheet, and 0.2 in both (43 errors/234 patients). Transcription errors in the paper log, the flow sheet, and in both resulted in 8, 24, and 2 insulin errors, respectively. As a consequence, patients were given a lower or higher insulin dose than the dose they should have received had there been no errors. Discrepancies in insulin doses were 2 to 8 U lower doses in paper log transcription errors, 10 U lower to 3 U higher doses in flow sheet transcription errors, and 2 U lower in transcription errors in both. Overall, 30 unique insulin errors affected 25 of 234 patients (10.7%). The average time from point-of-care testing to meter docking was 8 hours (median 5.5 hours), with some taking 56 hours (2.3 days) to be uploaded.Conclusions: Given the high dependence on glucometers for point-of-care blood glucose testing in intensive care units, full electronic medical record-glucometer interoperability is required for complete, accurate, and timely documentation of blood glucose values and elimination of transcription errors and the subsequent insulin-related errors in intensive care units.