The impact of a hospital electronic prescribing and medication administration system on medication administration safety: an observational study
The impact of a hospital electronic prescribing and medication administration system on medication administration safety: an observational study
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DOI：
10.1186/s12913-017-2462-2
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发表时间：
2017-08-09
影响因子：
2.8
通讯作者：
Franklin, Bryony Dean
中科院分区：
文献类型：
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作者：
Jheeta, Seetal;Franklin, Bryony Dean
工作背景：本研究的目的是探讨实施电子处方和药物管理系统（ePA）对住院医院环境中药物管理安全性的影响。目的是比较纸质和ePA系统之间的患病率和类型：1）给药错误和2）文件差异。此外，我们想描述任何观察到的变化，药物管理practices.Methods：这项研究是基于一个老年内科病房在英国医院。从2014年12月至2015年6月，使用中断时间序列方法，在ePA实施前后每5天观察一次护士给药查房。给药错误和文件的差异率前与后ePA进行了连续分析和卡方检验用于测试任何差异;分段回归分析，以确定纵向trend.Results的变化：观察在15前和15后ePA实施时间点。在ePA前的书面报告中，428次错误机会中有18次给药错误（4.2%; 95%置信区间2.3-6.1%），而ePA有18次给药错误（3.4%; 95%置信区间1.9-5.0%; p = 0.64）。关于文件，ePA前纸质文件中，460份观察到的文件中有5份不一致（1.1%; 95%置信区间0.1-2.0%）; ePA中，557份文件中有18份不一致（3.2%; 95%置信区间1.8-4.7%; p = 0.04）。最常见的电子文件差异是，在没有给药的情况下给药的文件。分段回归分析无法检测到任何显著的纵向变化。变化后，ePA的工作实践进行了观察，如护士表现出不太一致的自我检查时，准备和管理medication.Conclusions：研究结果表明，用药错误率没有变化，虽然ePA鼓励某些类型的错误和减轻他人。从统计数据来看，文件差异显著增加，这可能是由于采用了电子采购协议的新工作做法。
Background: The aim of the study was to explore the impact of the implementation of an electronic prescribing and medication administration system (ePA) on the safety of medication administration in an inpatient hospital setting. Objectives were to compare the prevalence and types of: 1) medication administration errors, and 2) documentation discrepancies, between a paper and an ePA system. Additionally, we wanted to describe any observed changes to medication administration practices.Methods: The study was based on an elderly medicine ward in an English hospital. From December 2014 to June 2015, nurses' medication administration rounds were observed every 5 days before and after ePA implementation using an interrupted time-series approach. Medication administration error and documentation discrepancy rates pre-versus post-ePA were analysed descriptively and chi-squared tests used to test for any difference; segmented regression analysis was used to determine changes in longitudinal trend.Results: Observations were made at 15 pre- and 15 post-ePA implementation time-points. Pre-ePA on paper, there were 18 medication administration errors in 428 opportunities for error (4.2%; 95% confidence interval 2.3-6.1%), and with ePA there were 18 in 528 (3.4%; 95% confidence interval 1.9-5.0%; p = 0.64). Regarding documentation, pre-ePA on paper there were 5 discrepancies in 460 observed documentations (1.1%; 95% confidence interval 0.1-2.0%); with ePA there were 18 in 557 (3.2%; 95% confidence interval 1.8-4.7%; p = 0.04). The most common electronic documentation discrepancy was documentation that a dose had been administered when it had not. Segmented regression analysis was unable to detect any significant longitudinal changes. Changes to working practices post-ePA were observed, such as nurses demonstrating less-consistent self-checking when preparing and administering medications.Conclusions: Findings suggest no change in medication error rate, although ePA encourages certain types of errors and mitigates others. There was a statistically significant increase in documentation discrepancies which is likely to be due to adoption of new working practices with ePA.